First Things First (assess & treat for the following)
- Assess airway, breathing, circulation
- Determine the severity of liver disease, presence of ascites.
- Assess intravascular volume status.
- Assess renal function.
- Consider admission of patient to intensive care unit.
- Insert Foley catheter and measure strict intake/output.
- If breathing is stable and there is no evidence of pulmonary edema, administer a trial of volume expansion using albumin infusion 1 g/kg IV (not to exceed 100 g).
- Consider central venous pressure monitoring.
- Adjust medications for renal and hepatic insufficiency
- Determine the type of hepatorenal syndrome (HRS) if present.
- Type 1 HRS: double creatinine to >2.5 mg/dL or 50% decrease in creatinine clearance to < 20 ml/min in < 2 weeks
- Type 2 HRS: progressive decline in renal function with creatinine >1.5 mg/dL, paralleling the development of refractory ascites
Hepatorenal Syndrome (HRS) has been found in Pocket ICU Management
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