The Clinical Problem Solvers Episode 389: Rafael Medina Subspecialty Series – Hypotension and Peaked T waves
Apr 11, 2025
In this engaging discussion, Dr. Samira Farouk, a transplant nephrologist and educator, and Dr. Douglas Farrell, an internal medicine resident and nephrology fellow, tackle the intricacies of hypotension and acute kidney injury. They highlight the importance of trending urine tests alongside traditional metrics like troponin. The duo also shares insights on managing hyperkalemia and the criteria for initiating acute dialysis, while introducing helpful mnemonics for diagnosing metabolic acidosis. Their clinical approach underscores the complexities of patient care in nephrology.
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Approach to Hypotension
- Assess hypotension by evaluating signs of end-organ damage early and rapidly.
- Use clinical examination, like checking skin temperature and cognition, to guide urgency and diagnose underlying causes.
Adrenal Insufficiency Effects
- Adrenal insufficiency can cause hypotension, tachycardia, hypothermia, and mild hyperkalemia.
- Combined with AKI, inability to excrete potassium worsens hyperkalemia and EKG changes.
Mechanisms of Hyperkalemia
- Effective potassium excretion requires glomerular filtration, distal sodium delivery, and aldosterone effect.
- Deficits in kidney function or aldosterone cause hyperkalemia, which can be managed via kidneys or GI tract with potassium binders.