From the Research
The duration of IV fluid administration for a patient with Acute Kidney Injury (AKI) should be individualized based on the patient's clinical status, with the primary goal of achieving and maintaining euvolemia, as suggested by the most recent study 1. The management of AKI involves a delicate balance between fluid administration and restriction, with the aim of preventing fluid overload and its associated complications, such as pulmonary edema. Initially, patients with hypovolemic AKI may require bolus fluid resuscitation with isotonic crystalloids (typically 0.9% normal saline or balanced crystalloids like lactated Ringer's) at 10-20 mL/kg over 1-2 hours, followed by reassessment. Some key points to consider in the management of AKI include:
- Fluid administration should continue until clinical signs of adequate volume status are achieved, including stable vital signs, improved urine output (target >0.5 mL/kg/hr), and resolution of signs of hypovolemia.
- IV fluids should be discontinued or restricted once euvolemia is reached to prevent fluid overload, which can worsen kidney function and lead to complications like pulmonary edema.
- Ongoing fluid management requires frequent reassessment of volume status using physical examination findings (edema, jugular venous distension, lung sounds), hemodynamic parameters, daily weights, and strict input/output monitoring.
- The underlying cause of AKI must be addressed simultaneously, as fluid therapy alone is not curative but supportive, as highlighted in 2 and 1.
- In oliguric or anuric patients, fluid restriction may become necessary after initial resuscitation to prevent volume overload, particularly if renal replacement therapy is not immediately available, as discussed in 3 and 4. It is essential to note that the choice of IV fluids in AKI will be dependent on the clinical context and clinicians' best judgment, until such time when definitive evidence exists to guide practice, as suggested in 5.