Pocket ICU Management

Hepatorenal Syndrome (HRS)

Hepatorenal Syndrome (HRS) is a topic covered in the Pocket ICU Management.

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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

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