ABSTRACT
This chapter presents a case study of a 55-year-old woman who is sent by her General Practitioner to the Emergency Department after presenting with a 3-week history of worsening shortness of breath, swelling in her legs and weight gain of 10 kg. The patient presents symptoms and signs of fluid overload and laboratory evaluation notable for evidence of acute kidney injury (AKI), with associated hyponatraemia, hyperkalaemia and metabolic acidosis. Classically, there are three major causative categories of AKI: pre-renal, renal and post-renal. The initial management of this patient in the High Dependency Unit (HDU) should focus on the two main complications that arise with AKI – volume and electrolyte issues. The electrolyte abnormalities that merit attention in this patient are hyponatraemia, hyperkalaemia and metabolic acidosis. Hyponatraemia will resolve with fluid removal but hyperkalaemia must be promptly treated. This patient may require renal replacement therapy (RRT) but should first be treated for volume overload and hyperkalaemia.
