Treat underlying cause
Prerenal: IVF (or pRBCs if bleeding)
Intrinsic: Depends on cause
Obstruction:
Note: Postobstructive diuresis can result in significant volume loss and death
Typically occurs when obstruction has been prolonged / has resulted in renal failure
Admit patients with persistent diuresis of >250 mL/h for >2hr
Foley Catheter, consider Coude Catheter
Suprapubic (if Coude fails)
Note: Postobstructive diuresis can result in significant volume loss and death
Typically occurs when obstruction has been prolonged / has resulted in renal failure
Admit patients with persistent diuresis of >250 mL/h for >2hr
Foley Catheter, consider Coude Catheter
Suprapubic (if Coude fails)
Typically occurs when obstruction has been prolonged / has resulted in renal failure
Admit patients with persistent diuresis of >250 mL/h for >2hr
Indicated for:
A: Acidosis (severe)
E: Electrolyte abnormality (e.g. uncontrolled hyperkalemia)
I: Ingestions (lithium, ASA, methanol, ethylene glycol, theophylline)
O: Overload (volume) with persistent hypoxia
U: Uremic pericarditis/encephalopathy/bleeding dyscrasia
Also:
Na <115 or >165 mEq/L
creatinine > 10
BUN >100
See Dialysis catheter placement
See Austere peritoneal dialysis
A: Acidosis (severe)
E: Electrolyte abnormality (e.g. uncontrolled hyperkalemia)
I: Ingestions (lithium, ASA, methanol, ethylene glycol, theophylline)
O: Overload (volume) with persistent hypoxia
U: Uremic pericarditis/encephalopathy/bleeding dyscrasia
Also:
Na <115 or >165 mEq/L
creatinine > 10
BUN >100
Na <115 or >165 mEq/L
creatinine > 10
BUN >100
Possible last ditch effort to tide patient over to formal dialysis if hours away
If traditional pulmonary edema treatments are not working for SCAPE patient, one may attempt to remove 200-300 cc of blood as a bridge to dialysis
If Hb too low, may consider temporary venous tourniquets on each leg proximally q30 min to reduce preload volume to the heart, alternating legs
Acute kidney injury
Acute hepatic failure
Acute urinary retention
Tumor lysis syndrome
Hepatorenal syndrome
Adrenal crisis
Renal infarction
Diabetes insipidus