Acute Kidney Injury V: Interprofessional Care

Fluid management involves regularly monitoring body weight, central venous pressure, and urine output to detect imbalances early. Nurses document intake and output carefully to prevent fluid overload, which can cause pulmonary edema and dyspnea. Signs of excess fluid include distended neck veins, lung crackles, and generalized edema. Loop diuretics like furosemide alleviate symptoms but do not improve kidney function.

Diuretics, antibiotics, and digoxin must be adjusted because kidney impairment slows their clearance from the body. Dosage reductions prevent medication accumulation and toxicity. Monitoring for adverse effects is crucial as declining kidney function reduces the body's ability to eliminate these drugs, increasing the risk of harmful side effects.

Calcium gluconate is administered first to stabilize cardiac membranes and prevent arrhythmias. Insulin and glucose are then given to shift potassium into cells temporarily. For ongoing management, patiromer or sodium polystyrene sulfonate removes potassium through the gastrointestinal tract. Severe hyperkalemia may require dialysis for rapid potassium reduction.

Dialysis is indicated for severe complications including fluid overload, hyperkalemia, metabolic acidosis, or significantly elevated blood urea nitrogen levels that cannot be managed conservatively. Altered mental status may also necessitate dialysis. Three options exist: hemodialysis for rapid waste removal, peritoneal dialysis for gentler filtration, and continuous renal replacement therapy for hemodynamically unstable patients.

Non-dialysis patients require 0.6 to 1.0 grams of protein per kilogram daily to reduce nitrogenous waste production. Dialysis patients need 1.2 to 1.3 grams per kilogram daily to compensate for protein losses during treatment. All patients receive 30 to 35 kilocalories per kilogram daily to prevent catabolism and support recovery.

Hemodialysis rapidly removes waste products and excess fluids through an artificial kidney but may cause hypotension from rapid fluid shifts. Continuous renal replacement therapy provides slower, continuous filtration suited for hemodynamically unstable patients, preventing rapid electrolyte and fluid changes. CRRT is preferred in critically ill patients requiring gentler treatment.

Sodium restriction prevents edema and hypertension development. Potassium and phosphorus intake are carefully adjusted according to serum levels to avoid further complications. Since impaired kidneys cannot effectively regulate these electrolytes, dietary restrictions help maintain safe serum concentrations and prevent life-threatening imbalances during acute kidney injury recovery.