CASE PRESENTATION-GROUP 3

ACUTE KIDNEY INJURY

• ZEEL-190614011
• ALAN JOY-190614014
• VAISHNAVI REGHUPRASAD-190614028
• SHEETHAL D SHETTY-190614030
WHAT IS ACUTE KIDNEY INJURY?
●
Acute kidney injury (AKI), also known as acute renal failure (ARF), is a
sudden episode of kidney failure or kidney damage that happens within a few
hours or a few days. AKI causes a build-up of waste products in your blood
and makes it hard for your kidneys to keep the right balance of fluid in your
body. AKI can also affect other organs such as the brain, heart, and lungs.
 ●
Symptoms
●
Etiological classification
•
Little or no urine when try to
●
Pre-renal: Nearly 55% of ARF urinate.
●
Due to decreased blood supply to ●
Swelling (edema), especially in
kidney. legs & feet
●
Renal: 40% ●
Loss of appetite
●
Due to direct damage to renal ●
Nausea & vomiting
parenchyma.
●
Feeling confused, lethargic,
●
Post-renal: About 5% vertigo
●
Due to obstruction in urinary tract. ●
Pain in the back just below the rib
cage
 Acute kidney failure

Signs Complications
• Urine output is low (20-500
ml/day) • hyponatremia
• Urine may be coloured or foamy
• Hypocalcemia
• Symptoms of hyperkalemia:
Paresthesia, • hyperkalemia
• muscle weakness, paralysis, • Hyperphosphatemia
diarrhea, ECG
• changes & even cardiac arrest • Metabolic acidosis
• Symptoms of hyponatremia- • Accumulation of urea
seizures.
• Pulmonary edema
and creatinine
• Infections
Classification
RHABDOMYOLYSIS INDUCED AKI
●
Rhabdomyolysis is a well-recognized cause of AKI, and
myoglobin, a oxygen carrier, is a causative compound of
rhabdomyolysis-induced AKI .
●
AKI develops in 10% to 40% of patients with severe
rhabdomyolysis.
●
The main mechanism of kidney damage in patients with
rhabdomyolysis is the massive release of myoglobin into the
circulation, with myoglobinuria
S.O.A.P ANALYSIS
 PROBLEM LIST
PPBLEM LIST
●
Acute Hepatitis/ Acute Pancreatitis- likely drug induced.
●
Acute Kidney Injury- Drug Induced/ Exertional
Rhabdomyolysis.
●
SUBJECTIVE EVIDENCE
1)Generalized weakness & Jaundice  1 month
2)Yellow discoloration of eyes
3)severe B/L thigh pain
4) Abdominal pain, Nausea, Vomiting
●
OBJECTIVE EVIDENCE
●
B/L Thigh (Distal 1/3rd )
Tenderness present.
• Urea: 101mg/dL
• S.Cr: 10.85 mg/dL
• AST: 1887 IU/L
• ALT: 467.0 IU/L
• Protein: 2+(221.0 mg/dL)
• Blood: 3+
• Bact: 64.10/hpf
• Yeast cells: 83.30/hpf
• Ca: 8.4 mg/dL
• Phos: 6.0 mg/dL
• Uric acid: 9.8 mg/dL
• CPK: 90558.0 U/L
• Urine Myoglobin: Positive
• CRP: 24.90 mg/dL
 Assessment

120 Urea

100

80
mg/dL

60

40

20

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Day
 Assessment

12 Creatinine

10

8
mg/dL

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Day
Assessment
ASSESSMENT
●
DIAGNOSIS-.Severe Rhabdomyolysis, Myoglobinuria, Acute Tubular
Necrosis, Oliguric Acute Kidney Injury.
●
ETIOLOGY- Exercise induced rhabdomyolysis

●
ASSESSMENT IF THERAPY IS
INDICATED:
●
Yes, to treat the discomfort associated with AKI ,reach the goals of
therapy and thus improve the QOL of the patient.
ASSESSMENT OF
STANDARD THERAPY
 Treatment of established ARF
• Renal replacement therapies (RRT) are the most common
nonpharmacologic treatment

• Renal replacement therapies come in two different forms

▪ intermittent therapies- hemodialysis
▪ continuous RRTs-continuous hemofiltration or peritoneal
dialysis

18
 Hemodialysis or hemofiltration is initiated when

• Severe electrolyte abnormalities cannot otherwise be

controlled (eg, K > 6 mmol/L)
• Pulmonary edema persists despite drug treatment
• Metabolic acidosis is unresponsive to treatment
• Uremic symptoms occur (eg, vomiting thought to be due to
uremia, asterixis, encephalopathy, pericarditis, seizures)
 Hemodialysis
• In hemodialysis, blood is heparinized
• And diverted of a large central venous cannula line and
actively pumped through the lumen of an artificial kidney
(dialyser) returning to the patient by a venous line.
• The dialyser consists of a cartridge comprised of either a
bundle hollow tubes or a series of parallel flat plates made of
a synthetic semi-permeable membrane.
• Hemodialysis involves diffusion of solutes across a semi-
permeable membrane.
• Dialysis fluid is perfused around the membrane in a
countercurrent to the flow of blood in order to maximize
diffusion gradients.

20
 21

HEMODIALYSIS- PROCESS
ASSESMENT OF
CURRENT THERAPY
Ceftriaxone (2g) IV Q24h [D1-D6]

• Brand name : Inj. Ceftriaxone

• Indication : hemodialysis prophylaxis
• Category: Cephalosporin antibiotic
• Dose and Duration : 2g of the drug to be taken per day intravenously
• MOA : Ceftriaxone selectively and irreversibly inhibits bacterial cell
wall synthesis by binding to transpeptidase that catalyzes the cross-
linking of peptidoglycan polymers forming the bacterial cell wall
• Contraindications: hypersensitivity, concomitant calcium adm,
concomitant lidocaine adm.
• Adverse Reactions : Abdominal cramps, bleeding gums, diarrhea,
nausea, vomiting, bloody nose, bloating, headache dizziness,
hypoprothombinemia, bleeding, hemolysis, hypersensitivity reactions
• Cost: Rs.105 per vial
CATHETER-RELATED BACTEREMIA (CRB)/ CATHETER-
RELATED BLOODSTREAM INFECTION(CRBSI)
• Catheter-related bloodstream infection (CRBSI) is defined as the presence of bacteremia
originating from an intravenous catheter. It is one of the most frequent, lethal, and costly
complications of central venous catheterization and also the most common cause of
nosocomial bacteremia.

• Antibiotic therapy for catheter-related infection is often initiated empirically. The initial
choice of antibiotics will depend on the severity of the patient's clinical disease, the risk
factors for infection, and the likely pathogens associated with the specific intravascular
device 
https://www.ncbi.nlm.nih.gov
• Management of the Hemodialysis Patient with
Catheter-Related Bloodstream Infection
Crystal A. Farrington and Michael Allon
• Antibiotic therapy, especially cephalosporin antibiotics are suggested in case
of catheter related infections.
• Dosing
Antibiotic dosing in renal failure patients should be done carefully as it has
significant effect on hepatic and renal functions. As per HMC/UWMC
Antimicrobial Renal Dosing Guidelines, 1-2g q12-24h dosage is safe for
normal renal function.
Clindamycin (600 mg) IV Q8h [D1-D5]
• Brand name: Inj. Dalacin
• Indication: hemodialysis prophylaxis
• Category: Lincomycin antibiotics
• Dose and Duration: 600mg drug taken intravenously every 8 hrs
• MOA: Clindamycin exhibits a bacteriostatic effect. It works by
primarily binding to the 50s ribosomal subunit of bacteria. This agent
disrupts protein synthesis by interfering with the transpeptidation
reaction, which thereby inhibits early chain elongation
• Contraindication: Hypersensitivity, chance of bacterial and fungal
superinfection, history of pseudomembranous colitis
• Adverse Reactions: Abdominal pain, nausea, esophagitis,
thrombophlebitis, pseudomembranous colitis, vomiting and diarrhea
• Cost: Rs.300 / vial
• Staphylococcus aureus Infections in Hemodialysis: What a
Nephrologist Should Know by Stefaan J.
Vandecasteele, Johan R. Boelaert and An S. De Vriese
• “Other antibiotics that are useful in the treatment of MRSA infections
in dialysis are daptomycin, linezolid, clindamycin, quinupristin-
dalfopristin, co-trimoxazole, and tigecycline “
• Dosing
• According to HMC/UWMC Antimicrobial Renal Dosing
Guidelines, 600-900mg IV q8h is safe for normal renal function.
Since the dosing in the prescribed clindamycin fell under this range
we conclude that the given dosage of Inj. Dalacin would be safe for
the patient.
Pantoprazole (40 mg) IV Q24h [D1-D18]
• Brand name: Inj. Pan
• Indication: acid reflux
• Category: Proton-pump inhibitors
• Dose and Duration: 40 mg drug taken intravenously once daily
• MOA: Pantoprazole exerts its stomach acid-suppressing effects by
preventing the final step in gastric acid production by covalently
binding to sulfhydryl groups of cysteines found on the (H+, K+)-
ATPase enzyme at the secretory surface of gastric parietal cell.
• Contraindication: hypersensitivity, concomitant rilpivirine adm,
CAUTION- severe hepatic impairement, CDAD and interstitial
nephritis
• Adverse Reactions: headache nausea, inj. site reactions, nausea
• Cost: Rs.49.70 / vial (Zepoxin 40mg – Rs.44.5)
• Recent studies have suggested a potential risk of AKI among PPI users.
However the results are conflicting.

• J A S N (Journal of the American Society of Nephrology)

Over time a number of concerns have been raised about renal events
associated with proton pump inhibitors, including hyponatremiea,
hypomagnesemia and specifically acute interstitial nephritis…both AKI and
AIN incidence and hazard ratio were higher among patients given PPIs
than among controls
• Proton Pump Inhibitors and Risk of Acute and
Chronic Kidney Disease: A Retrospective Cohort
Study, by Emily Hart
• The use of PPIs is associated with an increased risk of incident AKI
and CKD. This relationship could have a considerable public health
impact
Ondansetron (4 mg) IV Q8h [D1-D7, D12-15]
• Brand name: Inj. Emeset
• Indication: Nausea and vomiting
• Category: 5-HT3 receptor antagonist
• Dose and Duration: 4mg of the drug to be taken intravenously at every
8 hr interval
• MOA: Ondansetron is used to prevent nausea and vomiting. It’s a
selective antagonist of the serotonin receptor which initiate vomiting
reflux
• Contraindication: Hypersensitivity, co-administration with apomorphine
- [hypotension and loss of consciousness]
• Adverse Reaction: Headache, constipation, chills, drowsiness,
tiredness and restlessness
• Cost: Rs.13/ vial
• Justification: Ondansetron, metoclopramide, and haloperidol are
effective for uremia-associated nausea. ( pubmed.ncbi.nlm.nih.gov)
Calcium Acetate (667 mg) 1-1-1 [D1-D18]
• Brand name: Tab. Phostat
• Indication: Acute Kidney Injury/ Hyperphosphatemia
• Category: Phosphate binders
• Dose and Duration: 667 mg of drug to be given orally thrice a
day
• MOA: Calcium acetate is a phosphate binder. When taken with
meals it combines with phosphate in food to form calcium
phosphate which is excreted in the feces due to poor absorption
• Contraindication: Hypersensitivity, concomitant Ceftriaxone
administration
• Adverse Reaction: Stomach pain, increased urination, muscle
weakness, tiredness, thirst and partial/full loss of consciousness
• Cost: Rs.42/ strip of 10 tablets (Zerofos 667mg – Rs.38)
 JUSTIFICATION
• KDOQI Clinical Practice Guidelines for Bone Metabolism and
Disease in Children With Chronic Kidney Disease (American
Journal of Kidney Diseases, 2005)
• In Patients with CKD Stages 2-4: 6.1 If serum phosphorus levels cannot be controlled
within the target range (see Guideline 4), despite dietary phosphorus restriction (see
Guideline 5), phosphate binders should be prescribed. (OPINION) 6.2 Calcium-based
phosphate binders are effective in lowering serum phosphorus levels (EVIDENCE)
and should be used as the initial binder therapy. (OPINION) In Patients with CKD
Stage 5 (Dialysis): 6.3 Both calcium-based phosphate binders and the non-calcium,
non-metal-containing phosphate binders, such as sevelamer HCL, are effective in
lowering serum phosphorus levels. (EVIDENCE) As of this writing, calcium-based
phosphate binders should be used as primary therapy in infants and young children.
In older children and adolescents, either drug may be used.
• Dosing
• The drug is to be taken along with each meal. To avoid hypercalcemia avoid the use
of calcium supplements, including calcium-based non-prescription antacids
concurrently with calcium acetate
Febuxostat (40 mg) 0-1-0 [D1-D18]
• Brand name: Tab. Febuset
• Indication: Acute Kidney Injury/ Hyperuricemia
• Category: Xanthine oxidase Inhibitors
• Dose and Duration: 40 mg of the drug to be taken orally once daily
preferably at noon
• MOA: Febuxostat inhibits Xanthine oxidoreductase thereby reducing uric
acid production
• Contraindication: concomitant treatment with theophylline,
mercaptopurine and azothioprine
• Adverse Reaction: Rash, Nausea, Arthralgia, Liver function
abnormalities, diarrhea, breathing difficulty
• Cost: Rs.94/ strip of 10 tabs (Febzeal 40mg – Rs.58)
• Justification: The FDA (US Food and Drug Administration) approved
Febuxostat 40mg and 80 mg in 2009 for oral administration once daily for
chronic management of hyperuricemia
 JUSTIFICATION

• Febuxostat: A Novel Agent for Management of

Hyperuricemia in Gout by Manisha Bisht and S. S. Bist
• Febuxostat is indicated for the long-term management of hyperuricemia in
patients with gout. It was found to be more effective in the doses of 40-120
mg per day in lowering serum urate levels than the fixed daily dose of 300 mg
of allopurinol
• Febuxostat is an orally active drug found to be effective in the dosage of 40-
120 mg/day. The pharmacokinetics of the drug allows it to be suitable for
once a day dosing. The recommended starting dosage of febuxostat is 40 mg
once daily
• No dose adjustment required for mild to moderate renal failure but caution is
required for severe impairment
• Caution:- The FDA in 2019 added boxed warning for increased risk of
mortality with Febuxostat after concluding from a clinical study that there’s
increased risk of CV fatal outcomes in patients treated with it. So it has to be
strictly avoided in patients with cardiovascular diseases
Furosemide (40 mg) IV Q8h [D1-D3, D6-D7]
• Brand name: Inj. Lasix
• Indication: Acute Kidney Injury / Oliguria
• Category: Loop Diuretics
• Dose and Duration: 40mg of the drug to be taken intravenously
every 8 hrs
• MOA: Loop diuretics inhibit luminal Na-K-Cl co-transporter in the
Ascending Loop of Henle by binding to chloride transport channel,
thus causing sodium, potassium and chloride loss in urine
• Contraindication: Hypersensitivity, anuria
• Adverse Reaction: Headache, constipation, loss of appetite, chills,
muscle cramps, diarrhea, hyperuricemia, hypokalemia, profound
diuresis
• Cost: Rs.11 per vial( 4ml in a vial) [Furosemide (10mg/ml)]
• Inj.Frusizex 10mg :Rs.2.16 per vial(2ml in a vial)[Furosemide
(10mg/ml)]
 JUSTIFICATION
• Clinical Practice Guidelines on Acute Kidney Injury 5 th
Edition(2011), by UK Renal Association states that loop diuretics
have been used to convert patients with oligouric AKI to non-oligouric
AKI , to facilitate management of fluid and electrolyte disturbances
and reduce the requirement of RRT
• Austin Journal of Nephrology and Hypertension
Loop diuretics are used to enhance renal excretion of excess salt and
water. Loop diuretics have numerous reno-protective properties
that may help improve the management of Acute kidney injury and
subsequently patient outcomes.
• US Food and Drug Administration(LASIX dosage) :- The usual
initial dose of LASIX is 20-80mg given as a single dose. If needed the
same dose can be administered 6 to 8 hrs later or may be increased
by 20 or 40mg and given 6-8 hrs not sooner than previous dose.

https://renal.org/health-profes
sionals/guidelines/guidelines-
commentaries
Liq. paraffin + magnesium hydroxide (15 mL) 1-0-1
[D2-D18]
• Brand name: Syp. Cremaffin
• Indication: constipation
• Dose and Duration: 15 mL of the drug to be taken orally
twice a day [D2-D18]
• MOA: liquid paraffin acts as a lubricant laxative and
magnesium hydrochloride neutralizes hyperacidity in the
stomach and also has a laxative action.
• Contraindications: anorexia, diverticulitis
• Adverse Reactions: abdominal cramps, nausea
• Cost: Rs. 211/bottle of 225 mL syrup
Sodium Bicarbonate (500mg) 1-1-1 [D4-D18]
• Brand name: Tab. Sobisis
• Indication: Acute Kidney Injury/ Metabolic acidosis
• Dose and Duration: 500mg of the drug to be taken orally
thrice a day
• MOA: increases plasma bicarbonate, buffers excess H+
ions & raises blood pH
• Contraindication: diuretic-induced hypochloremic
alkalosis, hypercarbic acidosis, hypocalcemia
• Adverse Reaction: metabolic alkalosis, Milk-Alkali
syndrome, edema
• Cost: Rs. 38/ one strip of 10 tablets
 JUSTIFICATION
• Review Article on Sodium Bicarbonate Therapy
in Patients with Metabolic Acidosis by MaríaM.
Adeva-Andany, Carlos Fernández-Fernández, DavidMouriño-
Bayolo, Elvira Castro-Quintela, and Alberto Domínguez-Montero
Patients with advanced chronic kidney disease usually show
metabolic acidosis due to increased unmeasured anions and
hyperchloremia. It has been suggested that metabolic acidosis might
have a negative impact on progression of kidney dysfunction and that
sodium bicarbonate administration might attenuate this effect
• Clinical Practice Guidelines on Acute Kidney
Injury 5th Edition(2011), by UK Renal Association
recommends sodium bicarbonate therapy in AKI patients

PubMed (nih.gov)
Potassium Bicarbonate DS 1-1-1 (2 tsp) [D12-D15]
• Brand name: Syp. K Lite
• Indication: Acute Kidney Injury/ Metabolic acidosis
• Dose and Duration: 2 tsps thrice a day
• MOA: increases plasma potassium concentration
• Contraindication: hyperkalemia, concomitant K+ sparing
diuretic use, hypersensitivity
• Adverse Reaction: hyperkalemia, flatulence, abdominal
pain
• Cost: Rs.86/bottle
Pantoprazole(40mg) 1-0-0 [D19-D20]
• Brand name: Tab. Pan
• Indication: acid reflux
• Category: Proton-pump inhibitors
• Dose and Duration: 40mg of the drug to be taken orally once a
day preferably at morning
• MOA: Pantoprazole exerts its stomach acid-suppressing effects
by preventing the final step in gastric acid production by covalently
binding to sulfhydryl groups of cysteines found on the (H+, K+)-
ATPase enzyme at the secretory surface of gastric parietal cell.
• Contraindication: hypersensitivity, concomitant rilpivirine adm,
CAUTION- severe hepatic impairement, CDAD
• Adverse Reactions: headache nausea, inj. site reactions, nausea
• Cost: Rs.110 / strip containing 15 tabs
(Tab. Pepmark 40mg – Rs.35/strip containing 10 Tabs)
• Recent studies have suggested a potential risk of AKI among PPI users.
However the results are conflicting.

• J A S N (Journal of the American Society of Nephrology)

Over time a number of concerns have been raised about renal events
associated with proton pump inhibitors, including hyponatremiea,
hypomagnesemia and specifically acute interstitial nephritis…both AKI and
AIN incidence and hazard ratio were higher among patients given PPIs
than among controls
• Proton Pump Inhibitors and Risk of Acute and
Chronic Kidney Disease: A Retrospective Cohort
Study, by Emily Hart
• The use of PPIs is associated with an increased risk of incident AKI
and CKD. This relationship could have a considerable public health
impact
PLANNING

DISCHARGE MEDICATION
●

Drugs Strength Frequency No. of

days
Tab. 0-1-0 14 days
Supradyn
T. SUPRADYN 0-1-0
COST: Rs. 31/ strip (15 tablets)
COMPOSITION: ascorbic acid, ferrous sulphate, vit A, B12, B6, D3, E,
magnesium oxide, biotin, boron, calcium pantothenate ,thiamine.
INDICATION: deficiency syndrome, immunity booster
CATEGORY: Multi-vitamin and multi-mineral tablet
SIDE EFFECTS: acne, diarrhea
CONTRAINDICATION: peptic ulcer, appendicitis, pregnancy.
DRUG INTERACTION: antacids, Tetracycline, ciprofloxacin, aluminium
hydroxide
MOA: Minerals like calcium , iron etc helps in maintaining the adequate
functioning of the nerve , blood cells and bone. It inhibits the damage caused
due to free radicals thus slows the process of cell damage.
JUSTIFICATION: Multiminerals and multivitamins provides nutrients required
by the body and also helps kidney to regain its normal funtioning.
https://doi.org/10.1177/0884533611414029
 GOALS OF THERAPY
●
General Goals:
●
To prevent long term complications of acute kidney injury.
●
Minimize further renal injury that might worsen the condition.
●
Provide supportive standards untill kidney functions come back
to normal.
●
Patient Specific Goals:
●
Improve QOL of patient.
●
Treat underlying problems such as Rhabdomylosis,
Myoglobinuria, Acute Tubular Necrosis.
●
Relieve AKI discomfort and other symptoms.
 MONITORING PARAMETERS
●
Therapeutic:
●
S.creatinine
●
S.urea
●
CBC
●
GFR
●
Total and direct bilirubin, Electrolyte levels.
●
Toxicity:
●
Ceftriaxone- Thrombocytosis, Diarrhea, Rash,Elevated liver transaminases.
●
Clindamycin- Joint pain, White patches in the mouth, Heartburn.
●
Calcium acetate- Phosphate and calcium levels
●
Febuxostat- LFT
●
Furosemide- CBC, BUN/Cr
●
Sodium bicarbonate and Potassium bicarbonate- Acid- base balance.
 POINTS TO PHYSICIAN
●
His ACR, BUN, eGFR, urea(BUN)/creatinine ratio, creatinine clearance was not
calculated.
●
Potassium bicarbonate has higher chance of inducing hyperkalemia and is
contraindicated in AKI
●
Cephalosporins have low grade nephrotoxicity and is to be used in caution with
constant monitoring which was not done.
●
Serum Bicarbonate levels, vitamin D levels and urine sodium levels were not looked
into.
●
Diet modification was necessary but normal diet was advised
●
Chlorothiazide, Indapamide are the alternative drugs in the assesment of current
therapy. Non-calcium based phosphate binders like Sevelamer can be used instead of
Calcium Acetate as its contraindicated with Ceftriaxone
●
Levels of yeast cells were very evident but no medication was given.
●
Clindamycin can cause occasional liver damage and is to be used in caution with
hepatic impairment with constant monitoring which was not done.
●
Normal diet was advised.
PATIENT COUNSELLING
 POINTS TO PATIENT
●
About the disease:
●
Acute kidney injury (AKI), previously called acute renal failure (ARF), is a
sudden decrease in kidney function. It is very serious and requires immediate
treatment.
●
Here, damage to the kidney is due to exertional rhabdomyolysis (damage to
the muscle)
●
Breakdown products from the damaged muscle enters the circulation and AKI
is believed to be triggered by myoglobin-as the toxin causing renal
dysfunction.
●
Signs like myoglobinuria, reduced urine output and change in the urine
colour, hyponatremia, hyperkalemia. Hyperphosphatemia etc are seen
●
Swelling in legs and feet, loss of appetite, little or no urine when you try to
urinate, flank pain, nausea and vomiting are some of the common symptoms.
Symptoms will wear off when the insult to the kidney is reversed.
About drug:
●
SUPRADYN (0-1-0)- 14 DAYS

●
HOW TO USE THIS MEDICINE: Taken once daily as directed by the physician and
do not crush the tablet, swallow it as a whole.

●
IF DOSE IS MISSED: If a dose is missed then take it as soon as you remember. If it
is near the time of the next dose, skip the missed dose. Do not double the dose
to catch up.

●
STORAGE: Store at room temperature, away from light and moisture.

●
FOOD INTERACTION: Alcohol

●
AVOID DRUGS LIKE: Antacids, antibiotics( tetracyclines and quinolones).
HEMODIALYSIS
●
Removal of excess water and solute from the body
●
Solutes are removed through diffusion and convection.
●
HD- extracorporeal (dialysis membrane is outside the body
●
Without dialysis ESRD patients will die due to metabolic
complications.
 COMMON COMPLICATIONS IN HAEMODIALYSIS
PATIENTS
●
Infection (Sepsis/bacteremia)
●
Muscle Cramps
●
Thrombosis
●
Hypersensitivity
●
Hypotension
●
Folate deficiency.
 PROGRESS CHART OF THE
PATIENT:
Date Dialysi S.Cr S.Urea urine output CPK U/L
s mg/dl mg/dl (ml)

31/12 1ST 10.85 98 60 90558.0

1/1 2ND 10.09 86 120 -

2/1 3RD 9.02 63 100 -

3/1 4TH 5.80 30 130 6008.0

5/1 5TH 6.89 37 145 1488.O

7/1 6th 7.54 53 480 -

 LIFESTYLE AND DIET MODIFICATIONS:
●
Is advised to do yoga and exercise.
●
Quit smoking and alcohol consumption.
●
Regular medication will help in maintaining the severity of the
condition.
●
Strict diet modifications are required.
 DIET MODIFICATIONS:
●
According to KDIGO,
●
A total daily energy provision of 20-30kcal/kg/day.
●
Carbohydrate: 3-5kg/day
●
Protein: 0.8-1.0g/kg/day in a non catabolic patients with
AKI not receiving dialysis.
●
Fresh vegetables contain no added salt. Drain all the
cooking fluid before serving.
●
Canned fruits usually contain less potassium than fresh
fruits. Drain all the fluid before serving.
CALL YOUR DOCTOR RIGHT AWAY IF YOU NOTICE ANY OF
THESE SYMPTOMS:
●
Allergic reactions
●
Blistering or red skin rash
●
Severe abdominal pain, loss of appetite
●
Reduced urine output, change in urine color
●
Fever, vertigo, lethargy
●
Swelling of legs
 FOLLOW UP/ REVIEW
●
Review in MEDICINE OPD after 2 weeks with RFT AND CK.
 60

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