Emergency Department Management of Acute Kidney Injury, Electrolyte Abnormalities, and Renal Replacement Therapy in the Critically Ill

Emerg Med Clin North Am. 2019 Aug;37(3):459-471. doi: 10.1016/j.emc.2019.04.006. Epub 2019 May 24.


Acute kidney injury (AKI) is a common sequela of critical illness. Clinical manifestation of AKI varies and can include electrolyte abnormalities, anion gap, or non-anion-gap metabolic acidosis. Treatment strategies require careful identification of the cause of the AKI, relying on both clinical history and laboratory data. Once the cause has been identified, treatment can then target the underlying cause and avoid further insults. Conservative management should first be attempted for patients with AKI. If conservative management fails, renal replacement therapy or hemodialysis can be used.

Keywords: Acidosis; Acute kidney injury; Acute renal failure; Electrolyte derangement.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / therapy*
  • Critical Illness
  • Diuretics / therapeutic use
  • Emergency Medicine
  • Emergency Service, Hospital
  • Fluid Therapy
  • Humans
  • Renal Replacement Therapy*
  • Sodium Bicarbonate / therapeutic use
  • Vasoconstrictor Agents / therapeutic use
  • Water-Electrolyte Imbalance / therapy*


  • Diuretics
  • Vasoconstrictor Agents
  • Sodium Bicarbonate