Acute Kidney Injury, Severe Electrolyte Derangements and Renal Replacement in ICU — WACS Viva & Clinical Scenarios (ICU & HDU)

Exam-style acute kidney injury, severe electrolyte derangements and renal replacement in icu viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 55-year-old male is admitted to the ICU 3 days following an emergency small bowel resection for strangulated hernia. Over the last 24 hours, his total urine output has been 120 mL. He is tachypnoeic at 32 breaths/min, blood pressure is 100/60 mmHg on noradrenaline 0.2 mcg/kg/min, heart rate 110 beats/min, and he has a cumulative positive fluid balance of +8.5 litres with marked peripheral and sacral oedema. Laboratory investigations: serum potassium 7.1 mmol/L, urea 38 mmol/L, creatinine 520 µmol/L, arterial pH 7.12, HCO₃⁻ 9 mmol/L, lactate 3.8 mmol/L. His ECG reveals tall, peaked T waves an
• SCENARIO 2: A 30-year-old female marathon runner is brought to the ICU collapsed, hyperpyrexic (40.2°C), and in status epilepticus following extreme heat exposure. Following seizure control and cooling, laboratory results reveal serum sodium 112 mmol/L, potassium 5.8 mmol/L, creatine kinase 85,000 IU/L, and urine is dark tea-coloured. How will you systematically manage her severe symptomatic hyponatraemia, rhabdomyolysis-induced acute kidney injury, and what precautions will you take to prevent osmotic demyelination syndrome?
• SCENARIO 3: A 62-year-old female with long-standing poorly controlled hypertension and diabetic nephropathy presents with anuric AKI superimposed on chronic kidney disease. In your hospital, neither CRRT nor Intermittent Haemodialysis is immediately operational due to machine breakdown, but acute peritoneal dialysis consumables and rigid/flexible PD catheters are available. She is in severe respiratory distress from fluid overload and uraemic encephalopathy (blood pressure 210/115 mmHg, K⁺ 6.4 mmol/L, urea 45 mmol/L). Outline your critical care resuscitation and urgent bedside execution of acute peritonea
• SCENARIO 4: A 48-year-old male with septic shock receiving broad-spectrum antibiotics (meropenem, vancomycin, and colistin) for multi-drug resistant Klebsiella pneumoniae peritonitis is on continuous veno-venous haemodiafiltration (CVVHDF). Describe your systematic approach to drug dosing, therapeutic drug monitoring, and prevention of circuit clotting during continuous renal replacement therapy.