# Chapter 26: Nephrology Emergencies

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### 📖 Ready for a Deeper Dive?

Explore these related Lecture Series modules and Clinical Mastery reviews:

[🏆 Mastery: Flash Pulmonary Edema](https://urinenephrology.org/mastery/cardiorenal/flash-pulmonary-edema.html) [🏆 Mastery: SGLT2 Euglycemic DKA](https://urinenephrology.org/mastery/acid-base/sglt2-edka.html)

## Chapter 26: Nephrology Emergencies

### Severe Hyperkalemia (K+ \>6.5 mEq/L or ECG changes)

#### Immediate Management Protocol

1.  **Stabilize the Cardiac Membrane:** Calcium gluconate 1-2 amps IV. This is the first and most critical step to prevent fatal arrhythmias.
2.  **Shift Potassium Intracellularly:** Regular insulin 10 units + D50W 25g IV, and/or high-dose nebulized albuterol (10-20 mg).
3.  **Enhance Elimination:** Loop diuretics (if not anuric), potassium binders (e.g., SZC), and arrange for emergency dialysis if severe or refractory.

### Severe Symptomatic Hyponatremia

#### Acute Management for Seizures or Coma

1.  Administer a 100-150 mL bolus of 3% hypertonic saline over 10-20 minutes.
2.  The goal is a rapid 4-6 mEq/L increase in serum sodium to alleviate acute cerebral edema.
3.  May repeat bolus 1-2 times if symptoms persist.
4.  Once symptoms improve, slow the correction rate to avoid exceeding 8-10 mEq/L in 24 hours to prevent osmotic demyelination syndrome.

### Acute Pulmonary Edema

#### Emergency Protocol

1.  **Position:** Sit the patient upright to reduce venous return.
2.  **Oxygen:** High-flow oxygen or non-invasive ventilation (CPAP/BiPAP).
3.  **Diuretics:** High-dose IV loop diuretics (e.g., Furosemide 80-160 mg). A common rule of thumb is to give double the patient's total daily oral dose as an IV bolus.
4.  **Vasodilators:** Nitroglycerin (if hypertensive) to reduce preload and afterload.
5.  **Consider:** Emergency dialysis if unresponsive to medical management or anuric.

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