Clin Nephrol
-
Hyperkalemia is a common problem in hospitalized patients, especially those with underlying chronic kidney disease, but evidence-based guidelines for its treatment are lacking. Sodium polystyrene sulfonate (SPS), a cation exchange resin first approved by the FDA for the treatment of hyperkalemia in 1958, is frequently used alone or in conjunction with other medical therapies to lower serum potassium. Recently, the safety and efficacy of SPS have come into question based on multiple reported cases of bowel necrosis associated with SPS administration. ⋯ Our results suggest a serum potassium reduction of less than 1 mEq/L after administration of SPS for the treatment of acute hyperkalemia. Additionally, this study offers some evidence that the use of SPS may be associated with harm. We further note the need for standardized guidelines for the treatment of hyperkalemia at our institution.
-
Hemoperfusion (HP) or dialysis is occasionally used following carbamazepine (CBZ) toxicity but it remains unclear which is the most efficient modality. We describe a case of severe CBZ intoxication treated with different extracorporeal modalities during which CBZ toxicokinetics were compared. ⋯ All extracorporeal treatments facilitated CBZ elimination, although CVVH was significantly less efficient than IHD and IHD-HP. IHD-HP may be better than IHD alone but must be weighed against its risks. IHD appears sufficient to eliminate CBZ and may need to be repeated or prolonged according to the clinical context if CBZ absorption is delayed.
-
Studies have shown that adverse effects of dialysis are associated with increased risk of driving impairment. While recommendations have been made that physicians should place an increased focus on detecting risks for driving impairment among patients on dialysis, there are currently no diagnostic tools designed to help physicians assess driving impairment among this patient population. In addition to driver self-assessment tools provided by AAA (American Automobile Association), one of the only tools specifically designed to help physicians assess driver safety is the "Am I a Safe Driver?" checklist, originally designed to assess for driving impairment among geriatric patients. This study aimed to determine the utility of this checklist in detecting dialysis patients at risk for driving impairment. ⋯ Higher sensitivity and lower specificity of the "Am I Safe Driver" checklist implies that it is effective only as a preliminary screening test for ruling out risk of driving impairment among dialysis patients.
-
Acute kidney injury (AKI) occurs in up to 40% of patients undergoing cardiac surgery. Proenkephalin A 119-159 (pro-ENK) is a novel, stable surrogate biomarker for enkephalins, endogenous opioids involved in various physiological processes, including neurohormonal stress. ⋯ Pro-ENK is associated with prediction of AKI in patients undergoing cardiac surgery. Pro-ENK likely has decreased clearance in the setting of AKI. However, future studies analyzing this novel biomarker should be considered to further elucidate its clinical utility and to better understand mechanisms of renal injury.
-
Acute kidney injury (AKI) is common in the pediatric intensive care unit (PICU). We aimed to describe the etiology, clinical features, and outcome of AKI in pediatric patients and to determine the predictors for initiation of renal replacement and mortality. ⋯ Severe AKI predicted high mortality in critically ill children.