AKI CARE BUNDLE

INSTITUTE IN ALL PATIENTS WITH A 1.5x RISE IN CREATININE

OR OLIGURIA (<0.5mls/kg/hr) FOR > 6 HOURS

This is a medical emergency

Full set of physiological observations

Assess for signs of shock / hypoperfusion

If EWS triggering high, follow ABCDE approach. If unsure contact Seniors/ACRT/ITU

2222 if EWS >8

Initial AKI Care

Treat any Sepsis – in severe sepsis, antibiotics <1hr after recognition (following ‘sepsis six’ protocol)

Stop NSAIDs / ACEi / ARB / Metformin / K-sparing diuretic and review drug dosages

Dietetic assessment

Stop antihypertensives if relative hypotension

Avoid radiological contrast if possible.

Fluid Therapy in AKI

If hypovolaemic give bolus crystalloid / colloid 250mls until volume replete with regular review of response – avoid starch e.g. volulyte

Assess HR, BP, JVP, capillary refill, GCS

Call for senior review if >2 litres filling in oliguria

If fluid replete, maintenance fluids estimated at output plus 500mls – set daily target

If IV fluid maintenance required, give appropriate crystalloid solution

Monitoring in AKI

ABG and lactate

Daily weight and fluid input / output chart

Daily renal profile, ABG while creatinine rising

Minimum 4 hourly observations

Regular fluid assessment

Investigation of AKI

Mandatory in all AKI unless obvious precipitant

Urine dipstick. If proteinuria urgent spot urine Protein / creatinine ratio ( PCR )

Send MSU

Urgent renal ultrasound <24 hours after recognition (to rule out obstruction)

If PCR high, urgent urine BJP (myeloma)

Liver function (hepatorenal), CK (rhabdomyolysis). If platelets low blood film / LDH / bili / retics (HUS/TTP)

Chest X-Ray (overload)

ECG