Usually a patient in acute renal failure is unable to excrete sodium or potassium. Therefore it is usually necessary for their intake to be reduced to a minimum compatible with an adequate diet. Monitoring of electrolyte balance is achieved by regular measurement of plasma electrolytes.
Refractory hyperkalaemia is an indication for emergency dialysis.
Patients who are recovering from acute renal failure may become polyuric and may lose excessive amounts of sodium and potassium in the urine. In these patients there may be the need for potassium and sodium supplementation.
If the patient becomes hyperkalaemic there is an increased risk of the development of cardiac arrhythmias and subsequent cardiac arrest. There are typical ECG changes that may be seen in patients with hyperkalaemia. In acute onset hyperkalaemia measures such as the use of ion-exchange resins or the intravenous infusion of glucose and insulin may be used in the temporary management of this condition.
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