Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute renal insult (AKI) characterized by rapid rise in serum creatinine and oliguria, temporally associated with the subsequent development of acute cardiac dysfunction. Symptoms include dyspnea, orthopnea, and peripheral edema, with clinical evidence of volume overload and electrolyte imbalance (e.g., hyperkalemia) secondary to primary renal failure.
Clinical Examination Findings
Patient appears in acute distress with signs of fluid overload. Vitals: Tachycardic, hypertensive or hypotensive depending on cardiac output, tachypneic. Physical exam reveals jugular venous distension (JVD), bibasilar crackles on lung auscultation, and significant pitting edema (1+ to 4+) in lower extremities.
Treatment Protocol
Management focuses on stabilization of renal function and cardiac support. Strategy includes: 1) Optimization of fluid status via judicious diuresis or RRT (CRRT/HD) if refractory. 2) Correction of electrolyte abnormalities (e.g., hyperkalemia). 3) Cardiac support with inotropes or vasodilators as indicated. 4) Avoidance of nephrotoxic agents.