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Assessment 3
Lecture 2 Part 1
62
Aerospace Engineering
7th Grade
10/28/2013

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Term
top causes of AKI in ICU-3
Definition
drugs
hypovolemia
sepsis
Term
pts with underlying risk for AKI-3
Definition
af am, women, cancer
Term
drugs causing AKI-6
Definition
NSAIDS
chemo
penicillins
acyclovir
ampho B
aminoglycosides
Term
3 def of AKI
Definition
inc of Sr Cr 0.3 in 48 hrs increa SCr 1.5x w/i 7 days urine volume .5mL/kg/hr for 6 hrs
Term
AKIN criteria says SrCr rise within 48 hrs
Definition
Term
RIFLE crterisa says SrCr rise in 1-7 days and sustained for 24 hrs
Definition
Term
look at slide 18 for staging in AKI right before test
Definition
Term
pre-renal AKI
Definition
drop in BP stops flow to kidneys
Term
intrrenal AKI
Definition
direct damage to kidneys
Term
post renal AKI
Definition
obstruction of urine flow
Term
pre-renal repsonse to treatment is?
Definition
quick
Term
lab signs of pre-renal AKI-4
Definition
BUN>20
decreased BP
increased HR
Na<40
Term
causes of pre-renal AKI-4
Definition
diuretics
vasoconsticiotn form cyclosporin/ampho B
Heart failure
imapried renal autoregulation from ACEi/ARB/NSAIDS
Term
treatment for pre-renal AKI
Definition
treat underlying cuase
replace fluids (mild bleed=.9% Ns, renal/gi losses= .45%)
Term
types of damage leading to intrrenal AKI-4
Definition
acute tubular (ATN)
acute interstitial (AIN)
glomerluonephritis
vascular damage
Term
most intra renal AKI will return to nromal espeically if caused by?
Definition
drugs (may take days tho!)
Term
signs of intra renal AKI-4
Definition
elevated temp
BUN<15
NA>40
protein in urine
Term
causes of acute tubular necorsis-3
Definition
cyclosporin, aminoglycoside, cocaine
Term
causes of Acute interstitial necorsis-3
Definition
penicillin, cipro, sulfonamide
Term
treatment for vascualr or glomerluonephritis for intra renal AKI-2
Definition
corticosteroids
cyclophosphamide
Term
treatment for AIN in intrrenal AKI-2
Definition
corticosteroids
remove cuase
Term
treatment for ATN in intrrenal AKI
Definition
remove cause
Term
when is dialysis used?
Definition
sevre ecases
Term
signs of post renal AKI-4
Definition
BUN<15
Na>40
urine is normal
obstrucution on ultrasound
Term
what drugs cna cause kidney stones-3
Definition
indinavir
acyclovir
sulfanomides
Term
treatment for psot renal AKI-3
Definition
remove cause
catheter for bladder obsturuction
surgery for kidney stones
Term
2 most common cuases of AKI in ICU
Definition
rhabdo
contrast nephropathy
Term
treatment for contrast nephropahty?
Definition
no good ones, so do prophyalxis
Term
risk factros for contrast nephro-3
Definition
age>5
diabetes
female
Term
look on slide 38 for contrast enphro risk score, aks someon if need ot know!
Definition
Term
what volume of contrast dye has high risk for CN?
which test has this?
Definition
>100 mL
angiogram
Term
which types of contrast are better?-2
Definition
low osmolar 600-800
iso-osmolar- 290
Term
what is the best dye to use?
Definition
iodixanol (isomolar)
Term
use non ionic or ionic contrast dye?
Definition
non ionic
Term
gold standard for preventing CN?>
Definition
hydraiton therapy (esp oral)
Term
how does hydraiton therapy help prevent CN?
Definition
flushes radicals
counteract vasoconstriciton
Term
which fluid types shoudl be used for CN prevention?-2
Definition
isotonic slaine
bicarb
Term
urien flow rate for hydraiton therapy in CN should be wht?
Definition
150 ml/hr
Term
isotonic saline dose:
Definition
2 ml/kg/hr 12 hrs before and after contrast
Term
isotonic bicarb does
Definition
3 ml/kg/hr 1 hr before
1 ml/kg for 6 hrs after
Term
in emergency situaitons can give bicarb bolus of-
Definition
.5ml/kg
Term
is n acytlycystien recocmend for CN prophylaxis?
if you did which formulation would you sue nad why?
Definition
not really-
oral, less expesnive an dADEs
Term
n acytlcysteine PO dosing
Definition
600 bID day before and day of
Term
n actylcystine IV dose
Definition
600 mg bolus before and 1200 q 12 hrs x 4 after
Term
asocrobic acid and fenoldopam are sometimes reccomedned for-
Definition
CN prohylaxis
Term
if pt on statin and goingt o get contrast dye, what shoud be done?
Definition
keep on it, may have antioxidant properties to prevent CN
Term
what is rahbdo?
Definition
breakdown of skeletal muscle causing protein in circ
Term
risk of AKI devloping form rhabdo inceases with increased conc of?
Definition
creatine kinase
Term
look at slide 52 for pahtiphys of rhabdo
Definition
Term
what drugs cna cause rhabdo-7
Definition
alcohol
cocoaine
hypntocs
statins
fibrates
TCa/SSRI
antipsychotics
Term
features of rhabdo-3
Definition
increase CK MB
hyperK
tea colored urine
Term
rhabdo complicaitons that cause AKI-3
Definition
hypovolemia
acid urine <5.6
ferriheaemate has direct nephrotox->aTN
Term
Rhabdo treatment 1st thing
when shoud it be started?
what type?
Definition
hydraiton
w/i 6 hrs
9% (dont do lactated ringers->hyperK)
Term
what should be fluid rate used for rhabdo?
what is it adjusted to?
Definition
1500mL/hr
300 mL/hr
Term
contiue hydraiton for rhabdo until?
Definition
CK<1,000
Term
what is given to rhabdo pts with acidosis?
dose? -2
Definition
sodium bicarb
1 amp in 1L NS
2-3 amps in 1 L dextorse
Term
if pt doesnt respond to sodium bicarb can give?
Definition
acetazolamide
Term
when do you give pt mannitol in rhabdo?
what does i do
Definition
if cant get 300 mL/hr urine putput
promotes diuresis
Term
dosing of mannitol
Definition
20% sol with .5 g/kg over 15 min then
.1 g/kg/hr
Term
treatment options AKI:
crystalloids vs colloid?
Definition
crystalloids, less epxensive and fewer ADEs
Term
when do you use diuretics in AKI?
Definition
only if pt has volume overload
Term
what 3 drugs not reccomedned for AKI?
Definition
fenoldapam, atrial naturietic, dopamine
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