Table 50-2.

Indications, Doses, Adverse Effects, and Comments for Drugs Frequently Used in Cases of Acute Kidney Injury

Drug	Indication	Dosage	Adverse Effects	Comments
Furosemide	Fluid overload, oliguria/anuria, hyperkalemia	2 to 5 mg/kg IV bolus, may be repeated three to five times; 0.5 to 1 mg/kg/hr CRI if urine production increased following bolus	Ototoxicity; volume depletion (unlikely if patient is monitored)	Results are frequently not satisfactory in cases of severe AKI but adverse effects minimal, so use in anuric AKI
Regular insulin	Hyperkalemia	0.5 units/kg IV or IM, may be repeated every 4 to 6 hours, provided hypoglycemia is avoided	Hypoglycemia	Hypokalemic effect modest and transient; IV dextrose must be administered concurrent with and following insulin administration
Dextrose	Hyperkalemia; avoidance of hypoglycemia following insulin administration	IV bolus of 2 g/unit of insulin administered; bolus followed by CRI (the dextrose concentration and administration rate is dependent on serial blood glucose concentrations, patient's fluid status, and accessibility of central line)	Hyperglycemia, hyperosmolarity, hyponatremia, phlebitis with high dextrose concentrations	Dextrose should be diluted to avoid phlebitis; frequent changes in dextrose CRI frequently necessary based on serial blood glucose measurements
Calcium gluconate (10%)	Hyperkalemia; symptomatic hypocalcemia	0.5 to 1.5 mL/kg of 10% solution or 50 to 150 mg/kg IV slowly, to effect, while monitoring ECG; may be repeated	Worsening bradycardia and ECG changes; hypercalcemia; soft tissue mineralization	ECG should be monitored during administration; will not affect extracellular potassium concentration; effective in rapidly normalizing ECG but results transient; administration of large volumes may contribute to soft tissue mineralization
Sodium bicarbonate	Severe acidemia	to of the base deficit over 30 to 60 minutes, followed by an additional over the next 4 to 6 hours; additional dosing based on serial blood gas analyses	Paradoxical central nervous system acidosis, hypernatremia, fluid overload, hypochloremia; may cause or exacerbate hypokalemia if patient is polyuric; may exacerbate hypocalcemia	Requires close monitoring of blood gases and electrolytes for effective treatment and avoidance of adverse effects
Albuterol (inhaled)	Hyperkalemia	Four puffs; 90 microgram actuation via Aerokat device; repeated every 1 to 4 hours as necessary	Tachycardia, tremors, hyperexcitability	Adverse effects are uncommon at this dose; effects observed within 1 to 2 hours but may require multiple doses; effects can be sustained (several hours); only recommended for peracute hyperkalemia
Sodium polystyrene sulfonate	Hyperkalemia	2 g/kg per day PO or via feeding tube, divided into three to four doses per day; dose can be adjusted to effect	Hypernatremia, constipation, colonic necrosis	Rarely used except in chronic dialysis patients

AKI, Acute kidney injury; CRI, continuous rate infusion; ECG, electrocardiogram; IM, intramuscularly; IV, intravenously; PO, per os (orally).