YEAR 05 • ADVANCED CLINICAL

Anaesthesia & Critical Care

20 learning units • 100 chapter sections • 200 explained questions. Prepare patients for anaesthesia, recognise perioperative emergencies and understand organ support, critical-care teamwork and recovery.

Original RAHBAR study material for the Year 5 learning pathway. Clinical cases support supervised undergraduate learning. Treatment choices, doses and procedures must follow current local protocols and the responsible clinical team. References & further reading ↓

MODULE 17 / 20

Acute Kidney Injury & Metabolic Critical Care

Detect evolving kidney injury and recognise metabolic disturbances requiring urgent escalation.

Quick revision ↓ Medical Dictionary

01Recognise kidney injury

Acute kidney injury is identified through changes in creatinine or urine output using accepted criteria. Creatinine may lag behind the insult. Review baseline function, trends, fluid balance and clinical context rather than assuming that one laboratory result represents the full severity.

02Find reversible causes

Assess perfusion, infection, medication exposure and possible obstruction. Examine volume status and review relevant imaging or urine investigations. A catheter problem may explain low measured output, but persistent oliguria still requires clinical assessment and must not be dismissed automatically.

03Review medicines and fluids

Adjust medicines to renal function where appropriate and review nephrotoxic exposure with the prescribing team. Restore perfusion when depleted while avoiding unnecessary fluid in an overloaded patient. Maintain accurate intake, output and weight records to guide repeated decisions.

04Recognise metabolic emergencies

Severe hyperkalaemia, acidosis or symptomatic glucose disturbance can be life-threatening. Obtain urgent senior support and follow monitored treatment pathways. ECG changes can support concern about hyperkalaemia, but an apparently normal ECG does not guarantee that a high potassium level is safe.

05Escalate and follow up

Renal replacement therapy is considered for complications such as refractory hyperkalaemia, acidosis, fluid overload or uraemic problems, not a creatinine number alone. Survivors need review of renal recovery, medicines and future risk, with a clear follow-up plan after discharge.

High-Yield Revision

Creatinine may lag behind injury.
Assess fluid status before prescribing more fluid.
Dialysis decisions reflect complications and context.

Common Pitfalls

Assuming a normal ECG excludes dangerous hyperkalaemia.
Using a creatinine threshold alone to decide dialysis.

References & Further Reading

Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.

Reference review: 29 September 2026. Consult current local protocols for prescribing, procedures and escalation.