Basic Concepts of Fluid and Electrolyte Therapy

Clinical Features
There should be a high index of suspicion for AKI, particularly in an
acutely ill patient with risk factors. Information about the patient’s
previous kidney function (e.g. serum creatinine), particularly over the
preceding 3 months, is a vital part of the evaluation. As in every other
clinical condition, diagnosis is achieved by weighing all the evidence
derived from a full history, examination and appropriate investigations.
Serial changes in clinical features are often more revealing than
single measurements taken at any one time. AKI should be considered
as part of the differential diagnosis in patients presenting with the
following clinical features (Table 21).
Table 21: Clinical features of patients with suspected AKI and recommended baseline
investigations
History Examination Investigations
risk factors (Table 18)
symptoms
predisposing to
hypovolaemia
vomiting
diarrhoea
poor oral intake
blood/plasma loss
symptoms suspicious
of vasculitis
uveitis
skin rash
joint pains
haemoptysis
general
weight
temperature
skin turgor (over
clavicle)
mucous membranes
(misleading if
mouth breathing)
skin rash (vasculitis)
joint swelling
(vasculitis)
uveitis (vasculitis)
full blood count (FBC)
urea and electrolytes
(U&Es), including
chloride and
bi carbonate
acid-base status
(from arterial or
venous blood
gas analysis)
liver function tests
(LFTs)
calcium and phosphate
urinalysis (prior to
urinary catheter)
ultrasound of renal
tract within 24 hours
if obstruction
suspected
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