…patients with hepatic cirrhosis — creatinine based eGFR substantially overestimates renal function. Staging of chronic kidney disease Stage eGFR Description : : : G1 ≥ 90 Normal or high G2…

…good absorption and are best given orally when gut function is intact. Oral vancomycin (only for C. difficile) is likewise dosed independently of renal function…

…the bleeding risk of the procedure and by renal function. In markedly reduced renal function (dabigatran at eGFR <30 mL/min, the other DOACs at…

…key points Patients with renal insufficiency and cardiovascular disease, irrespective of diabetes status The clearest and most consistent cardiovascular signal is reduction in hospitalization for…

…Renal function biomarkers are essential in the evaluation and ongoing management of patients on sotalol. Because the drug is excreted unchanged primarily by the kidneys…

…The Modification of Diet in Renal Disease (MDRD) equation is a widely used tool for estimating the glomerular filtration rate (eGFR), which assesses kidney function…

…renal impairment. The cardiovascular burden of CKD extends beyond CAD to peripheral arterial disease, cerebrovascular disease, valvular heart disease, heart failure, atrial fibrillation, and other…

…the renal injury probably represents acute tubular necrosis arising from the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses. The kidney is…

…media and recently stopped drugs. 8. Treat sepsis, bleeding, shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the kidneys and urinary…

…address the cause, assess renal function and the rate of rise. Often outpatient or brief inpatient follow up depending on the clinical picture Moderate 6…

…acute kidney injury, hypoxia, shock, before contrast studies and before surgery. A risk of lactic acidosis SGLT2 inhibitor Stop in acute illness, fasting and surgery…

…ask which of the pCO₂ and the HCO₃ deviates most. What matters is which change can explain the pH, and whether the other variable lies…

…response and by repeated laboratory measurements, not by the values on admission alone. Diagnosis Current diagnostic criteria According to the international consensus report of 2024…

…patterns and formulary availability; check what applies where you work. They assume normal renal and hepatic function, a non pregnant adult of normal weight, and…

…the preparation Avoid in renal failure, heart failure, a history of peptic ulcer, and old age Titrate according to the effect and the respiratory rate…

…sheath, and a cell count plus albumin on the sample. Indications Diagnostic paracentesis: Newly detected ascites — always. Every admission of a patient with known ascites…

…maintaining or increasing kidney perfusion. Effects Dopamine 1 receptor agonists lower systemic blood pressure and increase renal perfusion. Time to onset of action 50 to…

…of oral anticoagulant used. Studies have shown that it performs similarly or superiorly to other bleeding risk assessment tools, such as HEMORR2HAGES, ATRIA, ORBIT, and…

…3 Interpretation of HEMORR₂HAGES score. Comparison with ATRIA and HAS BLED Scores Several studies have compared the predictive performance of HEMORR₂HAGES with other bleeding risk…

…prediction of long term outcomes after revascularization. It incorporates both anatomical (from the original SYNTAX Score) and clinical variables (e.g., age, sex, renal function…

…Most AAAs are located below the renal arteries and are related to atherosclerotic disease. At least 90% of AAAs larger than 4 cm are associated…

…with total and cardiovascular mortality ( Curtis et al ). Among patients with coronary heart disease, left ventricular function is actually a stronger predictor of death than…

…regimens, renal function thresholds and the division of work between the ambulance service, the emergency department and the PCI laboratory may differ between Swedish regions…

…prompt investigation for sleep apnoea, renal disease and secondary hypertension, and lead to one dose being moved to the evening. The fall can only be…

…Dose reduction in renal failure and in old age Amiodarone In severe haemodynamic compromise where the above cannot be used It also has a rhythm…

…0 mmol/L Triglycerides < 1.7 mmol/L 10 carries a risk of pancreatitis Cardiac markers and coagulation Test Reference Comment : : : High sensitivity troponin…

…Cocaine, amfetamine, other sympathomimetics, herbal remedies and performance enhancing preparations. Monoamine oxidase inhibitors and recent intake of tyramine rich food or interacting drugs. Corticosteroids, calcineurin…

…Identify drugs, renal failure, alcohol, a missed meal, physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes…

…vasodilatation. D1 and D2 (dopamine receptors): activation of D1 and D2 in the kidneys and the splanchnic vascular bed leads to renal and mesenteric vasodilatation…

…and in patients with diabetes or renal failure the index may be falsely normal because of medial sclerosis — in that case add toe pressure measurement…

…precedes respiratory depression and is the early warning sign. Choice of agent Situation Choice Reason : : : An opioid naive adult with normal renal function Morphine The…

…the last dose, the renal function and the severity of the bleeding 7 Manage antiplatelet drugs according to their indication. Do not routinely stop aspirin…

…be alkalinised. The kidney then chooses to excrete hydrogen ions instead of potassium, and the urine stays acidic however much bicarbonate is given. Potassium replacement…

…retention with renal impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient. Perioperatively and postoperatively…

…Warfarin has a narrow therapeutic index, a half life of several days and more than a hundred clinically relevant interactions. What determines whether the treatment…

…of ATRIA risk score. Comparison with other bleeding risk models Several bleeding risk assessment tools exist for patients with AF, including HAS BLED, HEMORR2HAGES, and…

…g in 1 ml vial. Dilute with 10 ml of normal saline and give by slow injection over 5 10 minutes. Dilute immediately before use…

…onset, prolonged duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute…

…dose : 0.5 3.0 μg/kg/min + + + +++++ Low dose dopamine stimulates D1 receptors and induces vasodilation in coronary, renal, cerebral and mesenteric vessels…

…avoid cyanide toxicity. • Dose dependent reduction in coronary and renal perfusion. • Dose dependent elevation of intracranial pressure (ICP) and reduction in cerebral blood flow. Caution …

Clinical medicine Emergency medicine Definition and pathophysiology Acute limb ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that…

…require reduction in patients with renal disease; neither amiodarone nor desethylamiodarone is dialyzable. The volume of distribution is large, averaging 60 L/kg, and the…

…shock. Patient related and procedural risk factors The risk of adverse events is increased by: advanced age; diabetes mellitus; chronic kidney disease or renal failure…

…venous and intra abdominal pressures, impaired renal venous outflow and persistent right sided congestion may be important mechanisms. Diuretics relieve the hemodynamic consequences of congestion…

…itself and may arise from non ischaemic cardiac conditions (such as myocarditis) or non cardiac conditions (such as renal failure). To establish a diagnosis of…

…failure, and end stage renal disease, may produce elevated troponin concentrations. The probability of MI increases continuously as the absolute hs cTn concentration rises. Early…

…and abrupt deterioration in renal function. By contrast, hypertensive urgency describes severe hypertension without clinical evidence of acute, ongoing target organ damage. Although BP reduction…

…natriuretic peptides promote vasodilation, renal sodium and water excretion, and reduction of cardiac fibrosis through activation of the natriuretic peptide A receptor. NT proBNP is…

…sinus rhythm and a heart rate above 70 beats/min. The reduction in the combined outcome of cardiovascular death or heart failure hospitalisation was related…

…particularly coronary artery disease. Hyperuricaemia and Endothelial Dysfunction Insulin resistance impairs renal tubular handling of uric acid and may contribute to hyperuricaemia. Uric acid may…

…diuretic for kidney function; Excess dietary sodium and volume overload; Concomitant drugs or conditions that increase blood pressure; or An undiagnosed secondary cause of hypertension…

…blood pressure Other cardiovascular risk factors and relevant comorbidities Evidence of hypertension mediated organ damage Existing cardiac, cerebrovascular, or renal disease The possibility of a…

…including the renal, carotid, vertebral and coronary arteries. In one study cited in the source material, FMD was identified in 86% of patients with SCAD…

…small vessels, multivessel disease, bifurcation lesions, treatment of acute myocardial infarction Procedural and mechanical Stent underexpansion, incomplete wall apposition, residual inflow or outflow disease, edge…

…presence of mitral stenosis, a mechanical heart valve or hypertrophic cardiomyopathy. Heart failure, hypertension, diabetes and vascular disease. Age and sex category. Renal and hepatic…

…Reduction of Sympathetic Drive Modulating autonomic tone is a pivotal therapeutic target [4]: Beta Blockers : Administered to reduce adrenergic stimulation [4]. Sedation and Intubation : Along…

…ineffective against alcohols, lithium, and heavy metals. Enhance elimination Induce diuresis through urine alkalinization, contingent upon renal elimination of the toxicant. This can be accompli

…of troponin being detected with conventional assays. False positive elevations of troponin are rarely explained by such interference ( Bularga et al ). Age, sex and renal…

…Causes of hypocalcemia Acute pancreatitis, pancreas surgery, alkalosis (hyperventilation), rhabdomyolysis, septicemia (sepsis), osteolytic cancer metastases, abnormal calcium absorption (gastrointestinal) and resorption (from primary urine), renal…

…effusion. Renal failure, hypothyroidism, and hypercholesterolemia. Dressler syndrome. Iatrogenic damage to the pericardium. Irradiation. Trauma. The most common cause of pericardial effusion is pericarditis. Because…