WorksheetsAKICRRT
Total questions: 8
Worksheet time: 5mins
Name
Class
Date
1.
A 72-year-old man with Hypertension came with slurred speech, headache and weakness after a fall at home. He had 3 days history of decreased oral intake, dizziness, fever, and yellow sputum production. A brain CT demonstrates moderate edema associated with an intracranial hemorrhage and mass effect. He developed PEA arrest and underwent successful CPR prior to ICU care and was on norepinephrine infusion after receiving 6L of IV fluids. Nephrology was consulted 6 hours later for anuric AKI and volume overload. He wass mechanically ventilated with FIO2 70% and remains on a norepinephrine infusion. He is febrile with elevated WBC count and mild thrombocytopenia. Chest radiograph is read as pneumonia with superimposed edema. Renal ultrasound is normal. Other pertinent laboratory studies:
(table1)
The nephrologist decides to initiate the patient on CRRT. Which of the following is the strongest evidence for supporting CRRT instead of intermittent hemodialysis (IHD)?
(table1)
The nephrologist decides to initiate the patient on CRRT. Which of the following is the strongest evidence for supporting CRRT instead of intermittent hemodialysis (IHD)?
a)
CRRT results in better renal recovery
b)
CRRT improves survival in hemodynamically unstable patients
c)
CRRT causes less intracranial pressure shifts in patients with acute brain injury
d)
CRRT improves patient survival in sepsis-mediated AKI
2.
Which ONE of the following statements regarding CRRT modalities is MOST correct?
a)
SCUF removes plasma water mainly by ultrafiltration and requires replacement fluid
b)
CVVH removes solutes and plasma water mainly by convection and ultrafiltration and requires replacement fluid
c)
CVVHD removes solutes and plasma water mainly by diffusion and ultrafiltration and requires replacement fluid
d)
CVVHDF removes solutes and plasma water mainly by absorption, diffusion, and ultrafiltration and requires both replacement fluid and a dialysate
3.
Which ONE of the following statements regarding solute clearance in CRRT is MOST correct?
a)
The sieving coefficient for urea decreases over time
b)
Solute clearance is inversely proportional to the effluent flow rate
c)
Small solute clearance is equivalent for CVVHD and pre-dilution CVVH if similar effluent and ultrafiltration rates are used
d)
A. The sieving coefficient for small molecular weight molecules such as creatinine is zero
4.
An 100 kg patient is on the following CRRT Parameters:
CVVHDF
Blood Flow 100 ml/min
Pre-Filter Replacement Fluid 1800 ml/hr
Dialysate 1000 ml/hr
Post-Filter Replacement Fluid 200 ml/hr
Fluid Removal 250 ml/hr
His HCT is 25%.
What is the CRRT prescribed dose?
CVVHDF
Blood Flow 100 ml/min
Pre-Filter Replacement Fluid 1800 ml/hr
Dialysate 1000 ml/hr
Post-Filter Replacement Fluid 200 ml/hr
Fluid Removal 250 ml/hr
His HCT is 25%.
What is the CRRT prescribed dose?
a)
19 ml/kg/hr
b)
28 ml/kg/hr
c)
33 ml/kg/hr
d)
49 ml/kg/hr
5.
An 100 kg patient is on the following CRRT Parameters:
CVVHDF
Blood Flow 100 ml/min
Pre-Filter Replacement Fluid 1800 ml/hr
Dialysate 1000 ml/hr
Post-Filter Replacement Fluid 200 ml/hr
Fluid Removal 250 ml/hr
His HCT is 25%.
What is the CRRT circuit filtration fraction for this patient?
CVVHDF
Blood Flow 100 ml/min
Pre-Filter Replacement Fluid 1800 ml/hr
Dialysate 1000 ml/hr
Post-Filter Replacement Fluid 200 ml/hr
Fluid Removal 250 ml/hr
His HCT is 25%.
What is the CRRT circuit filtration fraction for this patient?
a)
24%
b)
36%
c)
50%
d)
72%
6.
A 51 year old homeless man is admitted to the MICU with sepsis and multi-lobar pneumonia requiring mechanical ventilation. Blood and sputum cultures are positive for E. coli. Nephrology is consulted on hospital day 3 for AKI. He is mechanically ventilated and requires 75% FIO2. He is febrile, heart rate 122 beats/minute, blood pressure 95/60 mmHg on norepinephrine and vasopressin infusions, and CVP 16 cm H2O. Pulse pressure variation using hemodynamic monitoring is 8%. Examination of the chest reveals coarse breath sounds and inspiratory crackles throughout both lungs. He has generalized anasarca. He has made 250 mL of urine over the last 24 hours; he had made 500 mL over the preceding 24 hrs. His current weight is 80 kg (admission weight 71 kg).
(table 2)
Which of the following is the MOST appropriate next step in this patient’s management?
(table 2)
Which of the following is the MOST appropriate next step in this patient’s management?
a)
Start a continuous infusion of intravenous sodium bicarbonate
b)
Start a continuous infusion of intravenous furosemide.
c)
A. Initiate continuous venovenous hemofiltration (CVVH) with total ultrafiltration (effluent) rate of 1200 ml/hr.
d)
Initiate continuous venovenous hemodialysis (CVVHD) with effluent rate of 2000 ml/hr.
7.
Which ONE of the following is indicative of adequate citrate anticoagulation for CRRT?
a)
CRRT circuit ionized calcium level of 0.3 mmol/L
b)
Patient ionized calcium level of 0.7 mmol/L
c)
Serum citrate level of 1 mmol/L
d)
Patient total calcium level of 2.2 mmol/L
8.
A 79 year-old critically ill male with AKI is placed on CVVH with post filter replacement fluid. He has a hematocrit of 30% and weighs 68 kg.
(table 3)
His post-filter iCa levels are < 0.25 mmol/L. His access is a 13 French 15 cm double lumen catheter inserted in Right IJ. Which of the following management options BEST decreases the chance of further filter clotting?
(table 3)
His post-filter iCa levels are < 0.25 mmol/L. His access is a 13 French 15 cm double lumen catheter inserted in Right IJ. Which of the following management options BEST decreases the chance of further filter clotting?
a)
Switching to heparin anticoagulation
b)
Increasing the replacement fluid rate
c)
Increasing the blood flow rate
d)
Increasing the citrate rate
100 %
