Trauma, acute kidney injury and mannitol

Traumatic injury is a risk factor for acute kidney injury (AKI). The cause of AKI is likely multifactorial and may include renal hypoperfusion and renal hypoxia secondary to hypovolemic shock and/or increased abdominal pressure, rhabdomyolysis and direct nephrotoxic effects of therapy including general anesthesia (Harris et al., 2017). The osmotic diuretic, mannitol, has been used both in the prevention, and the treatment of AKI. It has been used peri-operatively to prevent the development of AKI and in the management of AKI secondary to traumatic rhabdomyolysis (Sharman et al., 2013; Yang et al., 2014). However, mannitol itself has nephrotoxic potential and therefore the benefits of its use should be considered in light of its potential to cause adverse effects (Perez-Perez et al., 2002;  Fang et al., 2010)

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Approach to Hypokalemia: Diagnosis and Treatment

All causes of hypokalemia can be divided into 3 big groups:

  • Decreased intake (unlikely to be a sole cause)
  • Intracellular shift
  • External loss (GI or renal)

A step-by-step approach to diagnosis of hypokalemia

Step 1: Review current medication history. Drugs that can promote hypokalemia (via intracellular shifting or increased losses/decreased intake):

  • K-deficient fluids
  • loop/thiazide diuretics
  • insulin, dextrose
  • albuterol, terbutaline and other beta agonists
  • catecholamines
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A Tricky Enterococcus

Enterococci are commensal bacteria inhabiting GI tract of animals and humans. It typically emerges in debilitated patients exposed to broad-spectrum antibiotics and as part of polymicrobial infections (especially, GI and/or urogenital). Enterococci are usually part of mixed aerobic and anaerobic flora, and antimicrobial regimens with minimal in vitro anti-enterococcal activity are often effective in treating mixed infections; therefore, the pathogenicity of enterococci in this setting is questionable. These and other factors limit the ability of investigators to determine the independent contribution of enterococcal infections to mortality and morbidity.

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Approach to Hyperkalemia: Diagnosis and Treatment

This blog post commences a series of articles on diagnostic and therapeutic approaches to potassium and sodium derangements. This is meant to be a quick reference/guideline for emergency veterinarians, students and technicians. All readers are welcome to leave feedback and comments below.

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