From the Guidelines
Renal failure patients require immediate recognition and intervention by paramedics to prevent further deterioration, with a focus on maintaining airway, breathing, and circulation, as well as managing fluid overload and electrolyte imbalances, as outlined in the most recent guidelines 1. Renal failure presents with various signs and symptoms, including altered mental status, nausea, vomiting, fatigue, shortness of breath, chest pain, edema, decreased urine output, and in severe cases, seizures or coma. The most critical aspect of paramedic treatment is to identify the underlying cause of renal failure, whether it be prerenal, renal, or postrenal, as this will guide the treatment approach 1.
Key Signs and Symptoms
- Altered mental status
- Nausea and vomiting
- Fatigue
- Shortness of breath
- Chest pain
- Edema, particularly in the legs and feet
- Decreased urine output
- Seizures or coma in severe cases
Paramedic Treatment
Paramedics should first focus on maintaining airway, breathing, and circulation while conducting a thorough assessment. Treatment includes:
- Administering oxygen to maintain saturation above 94%
- Establishing IV access for fluid management
- Cardiac monitoring to detect electrolyte abnormalities like hyperkalemia
- For fluid overload, furosemide (Lasix) may be administered at 0.5-1 mg/kg IV
- If hyperkalemia is suspected, calcium chloride 10% (10 mL) or calcium gluconate 10% (20-30 mL) can be given IV to stabilize cardiac membranes
- Sodium bicarbonate (50 mEq IV) may help with metabolic acidosis
- For symptomatic patients with severe hyperkalemia, consider albuterol via nebulizer (5-10 mg)
- Blood glucose should be monitored as renal patients often have diabetes Throughout transport, paramedics should maintain careful fluid balance, avoiding excessive fluid administration in patients showing signs of overload while ensuring adequate perfusion. Rapid transport to a facility capable of dialysis is essential for definitive care of severe renal failure, as indicated by the need for renal replacement therapy, which is a critical aspect of treating stage 3 acute kidney injury (AKI) 1.
From the Research
Renal Failure Signs and Symptoms
- Decreased urine output
- Fluid buildup (edema) in the body
- Electrolyte imbalances
- Uremia (buildup of waste products in the blood) 2
- Hyperkalemia (elevated potassium levels) 3, 4
Paramedic Treatments
- Restriction and binding of dietary potassium for mild hyperkalemia cases 3
- Correction of metabolic acidosis 3
- Increasing urinary excretion using furosemide 3, 5
- Infusion of glucose with insulin for moderate and severe hyperkalemia 3
- Salbutamol infusion to induce a shift of potassium into the intracellular compartment 3
- Nondialytic management for hyperkalemia and pulmonary edema among end-stage renal disease patients, including institution of dialysis if necessary 4
- Furosemide to achieve fluid balance and facilitate mechanical ventilation in patients with acute lung injury without hemodynamic instability 5
- Early recognition, diagnosis, prevention of further iatrogenic injury, and management of renal disease to prevent long-term morbidity and mortality 6