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Related Concept Videos

Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

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Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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Acute Kidney Injury III: Clinical Manifestations01:29

Acute Kidney Injury III: Clinical Manifestations

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Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
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Hemodialysis II: Procedure and Complications01:24

Hemodialysis II: Procedure and Complications

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DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
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Acute Kidney Injury VI: Nursing Management01:22

Acute Kidney Injury VI: Nursing Management

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Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
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Acute Kidney Injury I: Introduction01:22

Acute Kidney Injury I: Introduction

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Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
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Early Hyperchloremia and Outcomes After Acute Ischemic Stroke.

Adnan I Qureshi1, Wei Huang1, Francisco E Gomez2

  • 1Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, One Hospital Dr. CE507, Columbia, MO, USA.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|May 28, 2022
PubMed
Summary

Sustained high chloride levels (hyperchloremia) in acute ischemic stroke patients are linked to worse outcomes. Avoiding hyperchloremia may improve recovery and reduce death or disability at 90 days.

Keywords:
Acute ischemic strokeAcute kidney injuryAlbuminDeath or disabilityHyperchloremiaModified Rankin scale

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Area of Science:

  • Neurology
  • Critical Care Medicine
  • Clinical Chemistry

Background:

  • Hyperchloremia is associated with increased mortality in critically ill patients.
  • The impact of early hyperchloremia on acute ischemic stroke (AIS) outcomes requires further investigation.

Purpose of the Study:

  • To investigate the effect of early hyperchloremia on 90-day outcomes in patients with acute ischemic stroke.

Main Methods:

  • Analysis of AIS patients within 5 hours of symptom onset.
  • Identification and classification of hyperchloremia (≥110 mmol/L) at baseline, 24, or 48 hours post-randomization.
  • Logistic regression to assess the impact of hyperchloremia on favorable outcomes, death/disability, and death at 90 days.

Main Results:

  • Among 1275 patients, 191 had one occurrence and 108 had two or more occurrences of hyperchloremia.
  • Patients with two or more hyperchloremia occurrences had significantly higher odds of unfavorable outcomes (OR 3.0) and death or disability (OR 2.6) at 90 days.
  • Adjustments were made for age, stroke severity, study intervention, blood pressure, and intra-arterial treatment.

Conclusions:

  • Sustained hyperchloremia is independently associated with poor 90-day outcomes in AIS patients.
  • Avoiding hyperchloremia may potentially decrease unfavorable outcomes and reduce death or disability rates.