A fictional 72-year-old with diarrhoea, heart failure and several kidney-active medicines becomes oliguric. Potassium is rising, the ECG is abnormal and breathlessness with crackles is worsening.
Listen for the assumption.
Because of diarrhoea and AKI, I was going to give another rapid fluid challenge.
What findings make a reflex fluid prescription dangerous here?
Pulmonary congestion and worsening oxygenation. I need a whole-patient volume assessment while treating hyperkalaemia and escalating possible dialysis indications.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Potassium 6.7 mmol/L with broadening QRS complexes
- Urine output 80 mL over six hours
- Chest radiograph and examination support pulmonary oedema
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
Cardiac protection, potassium shift and definitive removal are separate jobs. Temporary improvement does not remove potassium.
Correct. Review medicines and obstruction, but do not let aetiology hunting delay treatment of the ECG and respiratory threats.
My handover will include urine output, potassium and ECG trajectory, volume assessment, respiratory support and the renal-replacement discussion.
What must remain explicit.
- Use current local and UKKA acute-hyperkalaemia protocols.
- Monitor ECG, potassium and glucose at protocol-defined intervals.
- Discuss potential renal replacement therapy immediately with renal/critical care.
Where reasoning fails.
- Treating creatinine rather than physiology
- Repeated fluid without reassessment
- Assuming intracellular potassium shift is definitive removal
Oliguric AKI with urine output [amount/time], potassium and ECG [trajectory], respiratory/volume findings [summary] and treatments [what/when/response]. I need immediate renal and critical-care input regarding [specific RRT indication].
How would you explain to a junior colleague why both more fluid and less fluid can be harmful in AKI?