Multiprofessional Critical Care Review: Adult 2024 (MCCRCA24ON)-Case Study Discussion 4 (AKI)

Case Study Discussion 4 (AKI)

Pdf Summary

This case study involves a 68-year-old woman with a history of hypertension who presents to the emergency department with fever, nausea, vomiting, and confusion. She is found to have acute kidney injury (AKI) likely due to sepsis. AKI related to sepsis is the most common cause of AKI in the ICU and is associated with worse outcomes. It is also a risk factor for secondary infections. The patient's AKI increases her risk for infections during her hospitalization.<br /><br />In terms of treatment options, early renal replacement therapy (RRT) has been shown to improve mortality in patients with AKI. However, in the absence of an urgent indication for RRT, careful monitoring is the best approach. Sodium bicarbonate infusion and diuretics have not been shown to improve mortality in AKI. Dopamine is not useful in preventing worsening kidney injury.<br /><br />There have been several studies examining the role of early versus delayed RRT in AKI. The AKIKI study found no difference in 60-day mortality between the early and delayed groups, and almost half of the patients in the delayed group did not require dialysis. The Start AKI trial also found no difference in 90-day mortality between the accelerated and delayed groups.<br /><br />In conclusion, this case highlights the common occurrence of AKI in sepsis and the increased risk of secondary infections. Early RRT may improve mortality in AKI, but careful monitoring is recommended in the absence of an urgent indication. Sodium bicarbonate infusion, diuretics, and dopamine are not beneficial in the treatment of AKI.

Keywords

acute kidney injury

sepsis

renal replacement therapy

secondary infections

early versus delayed RRT

AKIKI study

Start AKI trial

hypertension

emergency department

confusion

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