›Immediate stabilization workflow
›Cardiac monitor if potassium concern or instability
›IV access criteria
›Two large bore IVs if shock or severe hyperkalemia
›One IV if stable
›Oxygen if saturation less than 92 percent
›Point of care glucose if altered mental status
›If ECG hyperkalemia pattern, initiate temporizing therapy and resuscitation escalation
›Minimum initial bundle
›Repeat creatinine and electrolytes if outpatient abnormal
›Urinalysis and microscopy early
›Bladder scan early if low urine output or LUTS
›Renal ultrasound if obstruction concern or unclear etiology
›Sepsis evaluation bundle if infection suspected
›Hemodynamics and kidney protection
›If hypovolemia likely, isotonic crystalloid bolus 500 mL to 1000 mL then reassess
›If heart failure congestion likely, cautious diuresis strategy
›Stop nephrotoxins when possible
›NSAIDs
›ACE inhibitor
›ARB
›Metformin if significant AKI or hypoperfusion
›Hyperkalemia temporizing therapy when indicated
›Calcium gluconate 10 percent 10 mL IV over 2 to 5 minutes if ECG changes
›Regular insulin 10 units IV with dextrose 25 g IV
›Nebulized salbutamol 10 mg to 20 mg
›Sodium bicarbonate 50 mmol IV if severe acidosis and appropriate context
›Potassium removal
›Loop diuretic if urine output present and volume status allows
›Potassium binder if clinically appropriate and local protocol dependent
›Suspected urinary obstruction
›Foley catheter if retention likely and no contraindication
›Urology involvement if difficult catheter or obstructing stone with infection concern
›Suspected rapidly progressive glomerulonephritis
›Nephrology urgent involvement
›Avoid delays for serologies and urine microscopy review
Monitoring and reassessment loop
›Reassessment cadence
›Repeat vitals within 30 to 60 minutes after fluids or diuresis
›Repeat potassium within 1 to 2 hours after temporizing therapy
›Strict intake and output
›Daily weight if admitted
›Repeat creatinine within 6 to 24 hours depending on severity
Consultation and referral logic
›Who and when
›Nephrology same day for KDIGO stage 2 or 3
›Nephrology same day for suspected glomerulonephritis syndrome
›Nephrology same day for refractory electrolyte derangements
›Urology same day for obstruction with infection concern
›ICU consult for shock, severe pulmonary edema, or severe hyperkalemia with instability