(精选)Pediatric Acute Kidney Injury (AKI)教学课件.pptVIP

Management: Intravascular Volume Diuretics Augmentation of Loop with addition of Thiazide Augment loop diuretics by delivering more Cl to the distal tubule by blunting Na reaborption Fiser et al, Kid Int 1994 46:482 IV thiazide vs Control to augment loop in 10 adults with AKI Thiazide addition resulted in sig improvement in UOP 5mg/kg/dose q6 Diuril followed by Lasix IV q6 or Lasix gtt Management: Intravascular Volume Albumin good or bad? Finfer et al, NEJM 2004 350:2247 ~7000 adults with hypovolemia randomized to NS or 4% albumin No difference in AKI or need for dialysis BUT NS group received 1.3 times greater volume to restore hemodynamics Volume excess may be a negative indicator of survival in AKI Management: Intravascular VolumeDopamine ‘Renal-dose’ dopamine (0.5 to 3-5 mcg/kg/min) Increases RBF by promoting vasodilatation may improve UOP by promoting naituresis Not shown to alter course of renal failure Not proven to convert oliguric to non-oliguric AKI No effect in decreasing need for dialysis or improving survival in patients with AKI Bellomo et al, Lancet 2000 36:2139 RCT that revealed no change in survival b/w Dopamine and placebo Complications: tachycardia, arrhythmias, myocardial ischemia Management: Hyperkalemia “C BIG K Die” Calcium gluconate (from pharmacy) or Calcium chloride (on crash cart) Bicarbonate/beta-agonist (Albuterol) Insulin + Glucose Kayexalate Diuretic (Lasix) EKG changes: peaked T waves, flattened P waves, inc PR interval, widening of QRS, bradycardia, SVT/VT, and Vfib Management: Hyperkalemia SP Andreoli, Pediatr Drugs 10:379-390 Management: Acidosis Impaired acid excretion + increased acid production from underlying condition Administration where max resp compensation is adequate and/or acidosis is contributing to hyperK Plasma bicarb falls below 15 meq/L or arterial pH 7.25 Management: Acidosis Correction estimated by HCO3 dose = (16-measured HCO3)(0.4)(wgt in kg) Or empirically give HCO3 at dose of 1-2 meg/kg Avoid rapid