Hi Gary,
I am not sure that the 48hr value is the primary trigger. In any patient the serum creatinine could rise by >28 umol/l within 48 hours but by > 2.0 X reference value if one looks back 7 days. The algorithm reports the highest AKI stage which I think is correct.
Kind regards
Mike
Dr Mike Bosomworth
Clinical Service Lead for Blood Sciences and Specialist Laboratory Medicine
Tel: 0113 3922340
Mobile: 07789174344
In April – May I cycled solo from New York to San Francisco (4,320 miles), entirely self-funded, to raise money for the Yorkshire Brain Research Centre. If you would like to sponsor me then please visit:
www.virginmoneygiving.com/mikebosomworth. For more information about the ride and the charity please visit:
http://www.ybrc.org.uk/dr-mike-back-on-the-bike/
If you have already sponsored me then many thanks
-----Original Message-----
From: ACB AKI-Detection-Algorithm [mailto:[log in to unmask]] On Behalf Of Gary Mascall
Sent: 13 July 2015 11:15
To: [log in to unmask]
Subject: Query over 48 hour rule
I would like someone to look at the following scenario to decide which is the correct AKI warning alert for a patient:
Most recent Creatinine 254 umol/L.
Previous creatinine 47 hours 49 minutes previously 136 umol/L.
Lowest creatinine within last 7 days 116 umol/L.
So, looking at the National algorithm, this looks for the lowest value in last 7 days, and using this value of 116umol/L, finds the ratio is >2, so it will be AKI warning alert 2.
BUT, if you look at the original wording of the Renal Association document, it states:
Acute kidney injury is defined when one of the following criteria is met · Serum creatinine rises by ≥ 26μmol/L within 48 hours or · Serum creatinine rises ≥ 1.5 fold from the reference value, which is known or presumed to have occurred within one week
So there is a subtle, but noticeable difference, here the 48 hour value is the primary trigger, and using this interpretation the AKI warning alert would be 1.
Some advice /assistance would be welcome, because it appears the National algorithm has slightly changed the order in which things are calculated, which can give rise to a different interpretation.
Many Thanks,
Gary Mascall
Worcestershire Acute Hospitals NHS Trust.
********************************************************************************************************************
This message may contain confidential information. If you are not the intended recipient please inform the
sender that you have received the message in error before deleting it.
Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:
to do so is strictly prohibited and may be unlawful.
Thank you for your co-operation.
NHSmail is the secure email and directory service available for all NHS staff in England and Scotland
NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipients
NHSmail provides an email address for your career in the NHS and can be accessed anywhere
********************************************************************************************************************
|