›Time critical actions
›Monitoring and access
›Cardiac monitor if K elevation suspected
›IV access
›Immediate point of care checks
›Fingerstick glucose if altered
›ECG if K elevation suspected
›Rapid obstruction screen
›Bladder scan
›Foley catheter if retention likely
›Severe hyperkalemia treatment if present
›Calcium gluconate IV 1 g
›Repeat dose if ECG changes persist after 5 to 10 minutes
›Insulin regular IV 10 units with dextrose
›Dextrose 25 g IV if glucose < 14 mmol/L
›Nebulized albuterol 10 to 20 mg
›Sodium bicarbonate IV if severe acidosis
›Dialysis activation for refractory hyperkalemia
›Initial diagnostic path
›Labs
›BMP for K and bicarbonate
›Urinalysis with microscopy
›Infection evaluation when indicated
›Blood cultures
›Lactate
›Imaging for obstruction
›Bedside bladder scan then Foley
›Renal ultrasound if anuria or persistent oliguria
›Volume and perfusion management
›Hypovolemia without overload
›Isotonic crystalloid 500 mL bolus
›Reassess after each bolus
›Heart failure or pulmonary edema
›Avoid empiric fluids
›Noninvasive ventilation if needed
›Shock or sepsis
›Local protocol dependent resuscitation volumes
›Early vasopressor if fluid nonresponsive
›Etiology directed actions
›Postrenal
›Foley for suspected outlet obstruction
›Urology consult for failed catheterization
›Nephrostomy consideration for upper tract obstruction
›Suspected pyelonephritis with obstruction
›Broad spectrum antibiotics
›Urgent decompression pathway
›Medication related AKI
›Stop NSAIDs
›Hold ACE inhibitor and ARB during AKI
›Review nephrotoxin combinations
›Suspected glomerulonephritis
›Nephrology consult
›Avoid delay in workup when pulmonary hemorrhage concern
›Rhabdomyolysis
›Isotonic crystalloid infusion
›CK trend monitoring
›Time based reevaluation
›Urine output monitoring
›Hourly in severe AKI
›Foley output measurement
›Repeat labs
›Potassium recheck within 1 to 2 hours if treated
›Creatinine and bicarbonate within 4 to 6 hours if unstable
›Fluid balance and respiratory status
›Lung findings
›Oxygen requirement changes
›Post obstructive diuresis monitoring
›Urine output > 200 mL/hour for 2 hours
›Electrolyte monitoring frequency escalation
Renal replacement therapy triggers
›Dialysis indications
›Refractory hyperkalemia
›Persistent K 6.5 mmol/L or higher
›Ongoing ECG changes
›Refractory pulmonary edema
›Hypoxemia despite therapy
›Volume overload not diuretic responsive
›Severe metabolic acidosis
›pH < 7.1 with clinical deterioration
›Refractory to temporizing therapy
›Uremic complications
›Pericarditis
›Encephalopathy
›Bleeding with suspected uremic platelet dysfunction
›Toxin ingestion
›Local protocol dependent dialyzable toxins
›Poison control guidance