Basic Concepts of Fluid and Electrolyte Therapy

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Definition AKI is a result of a rapid fall in glomerular filtration rate occurring over hours or days. The consequences include a failure to regulate fluid and electrolyte balance and a failure to excrete metabolic waste products and drugs. AKI is defined when one of the following criteria is met; Serum creatinine rises by ≥26 µmol/l within 48 hours or Serum creatinine rises ≥1.5 fold from a baseline value measured within the previous week or Urine output is 6 consecutive hours If serum creatinine concentration has not been measured in the previous week, use the most recent creatinine concentration measured within the last three months. AKI can be staged according to the criteria in Table 19. Table 19: Stages of acute kidney injury Stage Serum creatinine (SCr) criteria Urine output criteria 1 increase ≥26 µmol/l within 48 h or increase ≥1.5-1.9 × baseline SCr 6 consecutive h 2 increase ≥2-2.9 × baseline SCr 12 h 3 increase ≥3 × baseline SCr or increase ≥354 µmol/l 24 h or anuria for 12 h 80
Any patient who meets the criteria for AKI should have a thorough clinical evaluation, which includes an assessment of volume status, fluid balance and medication chart in order to identify any potential causes for the AKI. In the majority of cases, AKI may be reversible if the cause is identified and appropriate management implemented. Aetiology of Acute Kidney Injury If the criteria for diagnosing AKI have been satisfied, it is important to identify its underlying aetiology as this will determine the most appropriate therapy and influence whether early referral to nephro - logy is necessary. AKI can be considered as pre-renal, intrinsic and post-renal (Fig. 10). Pre-renal and post-renal can both be considered as functional processes that may progress to damage to the parenchyma if not treated promptly. Figure 10: Classification of AKI ACUTE KIDNEY INJURY PRERENAL (functional) INTRINSIC (damage) POSTRENAL (functional) ACUTE TUBULAR INJURY INTERSTITIAL NEPHRITIS (10%) ACUTE GLOMERULONEPHRITIS (5%) ISCHAEMIA/SEPSIS TOXINS 81
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Dileep N. Lobo Andrew J. P. Lewingt
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Basic Concepts of Fluid and Electro
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Foreword This book, ‘Basic Concep
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Table of Contents 1. Normal Physiol
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ever, contains large anions such as
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Oral intake 1.5-2 L Saliva 1.5 L Ga
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Table 2: Normal maintenance require
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Kidney: this is the main organ for
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Conversely, if the intake of Na + i
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volume at all costs. It also explai
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Conclusion Appropriate fluid therap
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Intravascular fluid volume - the to
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Colloid - a fluid consisting of mic
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Base excess - Base excess is define
Page 30 and 31: Parameter Urine output Significance
Page 32 and 33: Figure 5: Example of a vital signs
Page 34 and 35: Fluid balance charts These provide
Page 36 and 37: Osmolality In the presence of AKI,
Page 38 and 39: Chloride Despite the fact that seru
Page 41 and 42: 4. Properties of Intravenous Crysta
Page 43 and 44: 6-12 h. The colloid should be metab
Page 45 and 46: Table 8: Advantages and disadvantag
Page 47: Plasma- Sterofundin 0.18% Plasma-Ly
Page 50 and 51: 50 Patients receiving artificial nu
Page 52 and 53: Once resuscitation has been achieve
Page 54 and 55: (3) The answer to this question is
Page 57 and 58: 6. Methods of Fluid Administration
Page 59 and 60: Central Modern single or multi lume
Page 61 and 62: 7. Acid-Base Balance Introduction M
Page 63 and 64: vide a simple description of the mo
Page 65 and 66: change in Pco 2 = respiratory proce
Page 67 and 68: Table 15: Causes of metabolic acido
Page 69 and 70: Renal HCO 3 - loss results from re
Page 71: Mixed acid-base disorders These are
Page 74 and 75: Urine output should be interpreted
Page 76 and 77: assess clinical response to fluid i
Page 78 and 79: Oliguria following surgery 48 h and
Page 82 and 83: AKI is most commonly secondary to a
Page 84 and 85: History Examination Investigations
Page 86 and 87: Management Prevention Any patient a
Page 88 and 89: if no clinical response and no pulm
Page 90 and 91: acidosis pH 7.2-7.4 - there is ver
Page 92 and 93: Referral to nephrologist NOT all p
Page 94 and 95: Follow up Acute kidney injury is a
Page 96 and 97: DKA and HONK represent the two extr
Page 98 and 99: Fluids and insulin In the absence
Page 100 and 101: Surgery in the patient with diabete
Page 102 and 103: 10 mmol/l/day. In the differential
Page 104 and 105: portionately more water is lost tha
Page 106 and 107: Hypokalaemia: a fall in serum conce
Page 108 and 109: Four common aspects of Ca 2+ disord
Page 110 and 111: Treatment depends on severity and c
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Page 114 and 115: Hypophosphataemia
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Page 118 and 119: Prolonged periods of preoperative f
Page 120 and 121: position to postoperative parotitis
Page 122 and 123: 13. *Chowdhury AH, Lobo DN. Fluids
Page 124 and 125: 42. Hussein H, Lewington A, Kanagas
Page 126 and 127: 67. *Michell AR. Diuresis and diarr
Page 128 and 129: 94. *Stewart PA. Modern quantitativ
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colloids 7, 26, 41, 42, 43 44, 45,
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intravascular compartment 20, 41, 4
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Stewart approach 63, 71 sympathetic
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Dileep N. Lobo Andrew J. P. Lewingt
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Basic Concepts of Fluid and Electrolyte Therapy

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