Clinical Case Scenario 1
An elderly woman, aged 76 and weighing 75 kg, is hospitalized to the Intensive Care Unit (ICU) with urosepsis. She experiences stage 3 Acute Kidney Injury (AKI). The urine output is 15-30 millilitres per hour. The creatinine level is 3.6 milligrams per deciliter (318.3 micromoles per litre). The urea level is 26 millimoles per litre. The potassium level is 5.2. The base excess is -7. Her current dosage of Noradrenaline support is 0.4 micrograms per kilogram per minute. The patient is currently on mechanical ventilation with a fraction of inspired oxygen (FiO2) of 0.6 and positive end-expiratory pressure (PEEP) of 10. The cumulative fluid balance is a positive 6 litres on the third day of the patient's stay in the intensive care unit. Below are the important vital parameters.
Heart Rate – 110 bpm
BP – 126/64
SpO2 – 98 %
RR - 18/minute
Question: What is the optimal management strategy?
