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ICU Nephrology

CKD after AKI in the ICU

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…

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Hypothermia Protocol and Dialysis

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…

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Renal Grand Rounds – Case of the month

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,…

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Spare the Chloride

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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Sepsis & AKI – an insoluble problem?

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Whole Lot of Pressure

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…

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“Dilutional Acidosis”

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…

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