BUMC Basics.pdf - Anesthesia Home

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Consider obtaining the following history or ordering
the following labs/studies:
• History: Any history of contrast, NSAIDS, nephrotoxins,
intravascular volume depletion (vomiting, diarrhea,
hemorrhage, diuretics, third spacing, burns), sepsis,
recent procedure or surgery (angiography, if CABG-check
aorta cross clamp time, check anesthesia log for any
episodes of hypotension), medication history, history of
renal disease, history of vasculitis
• UA with microscopy (simple test to perform and can
give you very valuable information)
• Consider bladder outlet obstruction. If Foley is in place,
is it blocked?
• Renal ultrasound to evaluate for hydronephrosis
• Urine spot Na, Cr at same time as BMP to calculate
FENa if oliguric
• Urine eosinophils if thinking about interstitial
nephritis/cholesterol emboli/ATN
Treatment:
• Treat underlying cause
• IV Fluids if needed
• Avoid nephrotoxins/contrast
• Renally dose medications
• See indications for renal replacement therapy below
BASIC ELECTROLYE REPLACEMENT
Can replete as below and then look for underlying cause of
deficiency.
Calcium: Check ionized calcium, then give one to two
amps of Calcium gluconate IVPB if low
Magnesium: Each 1 gram given increases the serum level
by about 0.1
MgSO4 comes as a 50% solution in 2cc amps
(2cc = 1 gm MgSO4 = 98 mg Mg = 4 mM Mg = 8 mEq
Mg)
Send blood and urine for Mg and Cr before replacing to
check FEx Mg