H Hemolysis
A Addisson's Diseases
R Renal Failure/Rhabdomyolysis
D Drugs: ARBs/Spironolactone and nephrotoxic agents
In an OSCE, first place the patient on monitored bed, cannulate, and get repeat samples for U & E, Creatinine, Calcium, and venous blood gases. Ask for an EKG to look for tall T waves.
Ask history of any Infections, injuries or renal disease, cardiac symptoms like chest pain/palpitations.
Background medical diseases like HTN, CHF, DM, Multiple myeloma, SLE
Drugs like ACEI, ARBS, Spironolactone, NSAIDS, Aminoglycosides, Amphotericin, recent contrast media imaging.
Treatment:
- 10 ml of 10% Calcium Gluconate slow IV push
- 50 ml of 50% Dextrose with 10 Units HAI over 10 minutes
- Nebulized Salbutamol
- Kayexalate PO or Enema
- NaHCO3 can also be used
- Lastly, HD and ICU care should be recommended for refractory hyperkalemia.
Treat Underlying cause:
Hydrate with IV Fluids
Stop all nephrotoxic drugs
Treat infections with antibiotics
Monitor UO
Note the Indications for Dialysis in Acute Renal Failure: AEIOU
- Acidosis (Metabolic Acidosis with pH < 7.2)
- Electrolyte disturbances: Refractory hyperkalemia
- Ingestions
- Overload (Fluid Overload: CHF)
- Uremia: Pericarditis/Encephalopathy
(Source: Trivedi, 2011)
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