A Practical Introduction to Intensive Care Renal Failure in addition to Renal Replacement T

A Practical Introduction to Intensive Care Renal Failure in addition to Renal Replacement T www.phwiki.com

A Practical Introduction to Intensive Care Renal Failure in addition to Renal Replacement T

Bellis, Bill, Meteorologist has reference to this Academic Journal, PHwiki organized this Journal A Practical Introduction to Intensive Care Renal Failure in addition to Renal Replacement Therapy Nicola Jones in addition to Jenny Shaw

Davenport College of Business, Grand Rapids US www.phwiki.com

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BACKGROUND Acute Renal Failure has major clinical significance

ICNARC Case Mix Programme Total of 276,326 admissions between 1995-2004 6.3% of these (17,326), developed severe acute kidney failure within the first 24hrs of admission to ICU Accounted as long as 9.3% of all ICU bed days ICNARC CMP: Mortality ICNARC CMP: Length of Stay

NCEPOD Report Examined the care of patients coded with a diagnosis of AKI who died in hospital between Jan 1st 2007 in addition to Mar 31st 2007 Sought to identify remediable factors in the care these patients received

NCEPOD: Key Findings Only 50% of care was considered good In 43% of patients there was an unacceptable delay in recognition 20% of all cases were both predictable in addition to avoidable Complications were missed in addition to managed badly Recognition of hypovolaemia in addition to sepsis was poor Lack of physiological monitoring was common Critical care outreach services .should have been involved further Additional patients should have received renal/critical care NCEPOD: Key Recommendations Postgraduate training should include awareness, causes, recognition, management in addition to complications of AKI WHAT IS ACUTE RENAL FAILURE Acute kidney dysfunction is characterized by an abrupt in addition to sustained decline in glomerular filtration rate which leads to accumulation of urea in addition to other toxins in the blood

HOW DO WE MEASURE RENAL FUNCTION U+E’s Urine output Glomerular Filtration Rate SERUM CREATININE Formed from non-enzymatic dehydration of creatine in liver Concentration is dependant upon muscle mass, liver function in addition to total body water Normal range 50-110 mol/L COCKCROFT-GAULT EQUATION (140-age) x weight x 1.23 or 0.85 Creatinine Cr 100mol/L 30 year old, 90kg, male 122mls/min 75 year old 60kg, female 40mls/min

Urea Not specific as long as renal failure GI bleed High protein diet Steroids Burns Urine Output <0.5mls/kg/min Severe renal impairment can exist despite normal urine output i.e. non-oliguric Oliguria may be a normal in addition to appropriate physiological response Glomerular Filtration Rate 24 hour creatinine clearance Limited accuracy Assumes steady state Overestimates GFR Inulin or radiolabeled iothalamate, DPTA or EDTA Clinical availability Chertow et al. JASN 2005; 16:3365-3370 Bellis, Bill ABC15 News at 10 PM - KNXV-TV Meteorologist www.phwiki.com

RIFLE CRITERIA Modification of Diet in Renal Disease 186 x (SCr)–1.154 x (Age)-0.203 DETERMINING BASELINE CREATININE 5,282 patients 67% had AKI mortality % Risk 8 Injury 11 Failure 26

More than 50% with RIFLE class R progressed to RIFLE class I More than one third of patients with class I progressed to class F Death CONCEPTUAL MODEL FOR AKI Complications Normal Increased risk Kidney failure Damage GFR AKI Risk Factors Hypovolemia Hypotension Sepsis Pre-existing renal, hepatic, or cardiac dysfunction Diabetes mellitus Exposure to nephrotoxins

LEARNING POINTS Anuria equals obstruction until proven otherwise Oliguria usually implies renal hypoperfusion Always per as long as m urinalysis WHAT ABOUT Frusemide Dopamine N-AC

Bellis, Bill Meteorologist

Bellis, Bill is from United States and they belong to ABC15 News at 10 PM – KNXV-TV and they are from  Phoenix, United States got related to this Particular Journal. and Bellis, Bill deal with the subjects like Meteorology

Journal Ratings by Davenport College of Business, Grand Rapids

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