Renal Emergencies in PICU: Electrolyte, Acid Base and Blood Pressure Issues

Abstract

This chapter discusses a clinical approach to a child with electrolyte and acid base abnormalities on the Paediatric Intensive Care Unit (PICU) with a focus on assessment and management. Judicious fluid management and astute attention to detail of the management of acid base and electrolyte abnormalities is vital in the management of critically ill children on PICU. In addition, this chapter discusses issues related to hypertension in critically ill children. Hypertension and hypertensive emergencies are commonly encountered in the intensive care unit. Appropriate management of hypertension depends on the precise assessment of the level of blood pressure, clinical status of the patient and recognition of any ‘red flag’ signs and symptoms. We discuss goals of pharmacotherapy and clinical factors to help decide rate of control of BP levels and antihypertensive agent. Transition of children from intravenous antihypertensive agent to an oral agent and plans for follow-up of children with severe hypertension beyond ICU are also discussed.