Contrast-associated acute kidney injury is a controversial subject. The available evidence is reassuring that significant acute kidney injury, death, and need for renal replacement therapy are rare after IV contrast administration.

Use of insulin/glucose to treat hyperkalemia works, but hypoglycemia is a common side effect. Here are some pearls to give this treatment more safely.

ECG can’t be used to rule out hyperkalemia. It may be present and electrocardiographically silent. But if you see the changes, ECG can be used to rule it in. Sensitivity was 19%; specificity 97%.

Once insured, undocumented immigrants with end-stage renal disease (ESRD) who were then able to get scheduled vs emergency-only hemodialysis (HD) has a drop in 1-year mortality (NNT = 7) and saved almost $6,000/person/month in healthcare costs.

The IDSA now only recommends screening for and treating asymptomatic bacteriuria (ASB) in pregnant women and those undergoing an invasive urologic procedure.

Hyperlactatemia appears to arise from impaired oxygen utilization more often than decreased O2 delivery but doesn’t cause acidemia unless there is impaired renal function. The novel “alactic base excess” may give us an early way to tell when the kidneys are failing to compensate.

The AAP now recommends isotonic fluid (+/- KCl and dextrose) in children >28 days to <18 years who need maintenance IV fluid, as opposed to hypotonic solutions.

Hyperchloremia (an increase ≥5meq/L) in the first day of PICU admission was independently associated with 2.3 times greater odds of in-hospital death in critically ill children.

Medical therapy for hyperkalemia is highly variable and will drop the level by about 1mmol/L in 4 hours. Dialysis dropped it about 2.2mmol/L in 4 hours.

Highly resistant, extended spectrum β-lactamase (ESBL) producing Enterobacteriaceae in the urine are becoming increasingly common in unexpected patients in the ED.