# Managing Sepsis-Induced Acute Kidney Injury in the ED
> Explore a clinical case study on recognizing sepsis deterioration and Stage 3 Acute Kidney Injury (AKI) using the Sepsis Six bundle and NEWS2 criteria.

Tags: sepsis, acute-kidney-injury, nursing, emergency-medicine, clinical-case-study, sepsis-six, medical-education
## Slide 1: Recognising and Responding to Acute Deterioration
- Case study on Acute Kidney Injury (AKI) secondary to sepsis.
- Focus: Emergency Department nursing care.

## Slide 2: Introduction and Case Overview
- Patient: Mr. Pearce (pseudonym), 68 years old.
- Admitting diagnosis: Suspected urosepsis.
- Scope: Deterioration detection, physiological mechanisms, and escalation.

## Slide 3: Patient Profile and Background
- History: Type 2 Diabetes, Hypertension, BPH.
- Medications: Metformin, Ramipril (ACE inhibitor), Tamsulosin.
- Symptoms: Dysuria, fevers (38.9°C), rigors, and confusion.

## Slide 4: Initial Clinical Assessment
- Vital Signs: BP 88/54 mmHg (hypotensive), HR 118 bpm, RR 24, SpO2 93%.
- Scoring: NEWS2 Score 12 (High Risk), qSOFA Score 3/3.

## Slide 5: Subtle Cues and Clinical Reflection
- Key Risks: Confusion initially attributed to age; oliguria underestimated.
- Missed Parameters: Delayed lactate and fluid balance monitoring; blood cultures drawn after antibiotics.

## Slide 6: Pathophysiology of Sepsis-Induced AKI
- Lab Results: Creatinine 387 μmol/L, Urea 22.1 mmol/L, eGFR 14 mL/min, Lactate 4.2 mmol/L.
- KDIGO Criteria: Stage 3 AKI identified.
- Mechanism: Systemic inflammatory response leading to renal hypoperfusion and structural tubular ischaemia.

## Slide 7: Sepsis Six Bundle Implementation
- Actions within 1 hour: 15L O2, blood cultures, Piperacillin-tazobactam IV, 30 mL/kg NaCl bolus, lactate measurement, and urinary catheter (IDC).

## Slide 8: Management Outcomes
- Successes: Appropriate NEWS2 escalation and transfer to HDU.
- Outcome: Creatinine trended down over 72 hours; patient did not require renal replacement therapy.

## Slide 9: Conclusion
- Importance of early recognition using NEWS2/qSOFA.
- Nurses serve as the first line of detection in clinical deterioration.
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