Renal Emergencies: Hyperkalemia and AKI

The kidneys do four jobs that cannot be paused: they excrete potassium, they excrete sodium and water, they regenerate bicarbonate and excrete acid, and they clear the waste products of protein metabolism. An acute kidney emergency is what happens when one or more of those jobs stops faster than the body can compensate. The danger is rarely the creatinine number itself. The danger is what the failing job allows to build up: potassium that stops the heart, fluid that floods the lungs, acid that depresses circulation, and uremic toxins that cloud the brain and inflame the pericardium. That is why the first question in every renal emergency is not "what is the creatinine?" but "what is threatening this patient in the next hour?" Cardiac rhythm, airway and breathing, circulation and level of consciousness come first. Identifying the cause of the kidney injury and planning longer-term care come after the immediate threats are controlled. The major renal emergencies a Canadian RN must recognize are: - acute kidney injury (AKI); - severe hyperkalemia; - severe metabolic acidosis; - pulmonary edema associated with...