Literature shows that over half of the patients admitted to the intensive care unit (ICU) will eventually develop some degree of acute kidney injury (AKI). The development AKI imparts significant repercussions to both the acute and long term…
Patients with intracranial hemorrhages often develop cerebral edema, which can create unique challenges when providing maintenance hemodialysis. Conall also covering this on RFN a few years back. Hemodialysis can worsen cerebral edema through a rapid decrease in serum…
I give a regular talk to the residents in the ICU on CRRT and one of the things that I focus on is prognosis. We all know that the outcomes of patients requiring CRRT in the ICU are…
I recently received an inpatient consultation to see a CKD 5D patient. The reason for consult, as is mostly the case with dialysis patients was that he “needs hemodialysis”. This dialysis patient wasn’t the average bear though. He…
A young woman with h/o polysubstance abuse and seizures was admitted to hospital with status epilepticus. She was treated with a propofol infusion at 5mg/kg/hr which was maintained due to perceived continuing seizure activity. On hospital day 5,…
Yet another manuscript evaluating fluids for IV replacement was published in JAMA this week underscoring the importance and controversial nature of the topic. A large meta-analysis involving 10,868 patients from 38 trials showed that hydroxyethyl starch (HES) was…
Fluid therapy is essential in ICUs and not surprisingly there is still much controversy about which fluid to use, how much and when. Nephrologists often roll their eyes at other subspecialty’s preferences, e.g. surgeon’s preferences for Ringers, citing…
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The maintenance of mean arterial pressure to prevent tissue dysoxia and conserve organ function is central to the management of the critically ill. In patients with increased capillary permeability this is often achieved by administration of large volumes…
Though this is to some degree controversial, volume expansion with normal saline has been associated with the development of a hyperchloremic, non-anion gap metabolic acidosis. What are the mechanisms associated with saline expansion-induced metabolic acidosis? The rationale for…
