Management of the acute renal failure patient

摘要

First and foremost in managing patients in acute renal failure (ARF) is a complete assessment of their initial hydration, blood pressure, mentation, cardiovascular status, red blood cell concentration, and status of urine output. All treatment orders must then be carried out within the pathophysiologic context of each individual patient. Any moderate to severe anemia; hypoproteinemia; cardiac dysfunction; pulmonary pathology; and oliguria, anuria, and polyuria will call for modifications designed to meet the needs of the patient. Efforts should be taken to avoid administering any potentially nephrotoxic drugs. Fluid Therapy. Volume depletion is treated by replacing estimated deficits and ongoing losses with appropriate fluid and electrolyte therapy. In the absence of severe hypovolemia and oliguria, half of the estimated fluid deficit can be given over the first 2-4 hours with the remaining deficit and maintenance volumes over the following 20-22 hours. Oliguric patients should receive their fluid replacements slowly. In most situations, dehydration deficits are replaced with isotonic solutions such as 0.9 percent NaCl or lactated Ringers' solution. Maintenance volumes can be administered as one-half strength solutions if normal blood pressure is being maintained.