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Program Overview

Acute Kidney Injury and Hyperkalemia: Critical Management in the ED and ICU 

This EMCREG-International On the Go Symposium serves as a state of the art evaluation of acute renal failure with resulting hyperkalemia for practicing emergency physicians, hospitalists, and intensivists.  The five faculty members presenting in this symposium are experts dual trained in Emergency Medicine and Critical Care Medicine.  Through this critical care approach to the evaluation and treatment of acute kidney injury (AKI) and resulting hyperkalemia, clinicians caring for these patients in the acute care setting (ED and ICU) will be better prepared to mitigate further kidney injury and treat life-threatening hyperkalemia. The five faculty members will discuss the causes of AKI, comprehensive treatment of hyperkalemia, improving cardiovascular management of critically ill patients to minimize AKI, and early ventilator management in the emergency patient to reduce hypoxia which can further damage the kidneys.

Target Audience
This program is designed for Emergency Physicians, Hospitalists, Critical Care Physicians, Emergency and Critical Care Nurses

Learning Objectives
After successful completion of this educational activity, participants should be able to:

  • Describe the causes of Acute Kidney Injury (AKI) and acute management of patients with this condition in the Emergency Department and Critical Care Environment
  • Describe the symptoms, signs, laboratory, ECG findings, and pathophysiology of hyperkalemia
  • Describe and discuss the treatment algorithm/critical pathway for management of hyperkalemia in the acute care setting
  • State the parenteral treatment options for hyperkalemia in the acute care setting including calcium gluconate, insulin and glucose, sodium bicarbonate, beta agonists, and emergent hemodialysis
  • Identify the types of delays encountered in the ED setting that impact treatment of patients with potentially life-threatening hyperkalemia
  • Describe the oral potassium cation exchange agents including sodium polystyrene sulfonate, patiromer, and sodium zirconium cyclosilicate and their mechanism of action
  • Discuss the Phase 3 trial using the oral agent for hyperkalemia sodium zirconium cyclosilicate versus placebo and discuss the mechanism of action versus other oral cation exchange agents for hyperkalemia
  • Describe the various adjuncts for improving the hemodynamic state for patients with evolving AKI in the ED and ICU
  • Discuss the optimal early ventilatormanagement in the Emergency Department and Intensive Care Unit to maximize blood oxygen levels and decrease injury to the kidneys


CME/CE Certified On-Demand
Lecture Series

Upcoming Lectures

There are no meetings currently scheduled in this subject area.

Agenda Topics

Acute Kidney Injury and Hyperkalemia: Critical Management in the ED and ICU

Causes of Acute Kidney Injury (AKI) - Rhonda Cadena, MD, University of North Carolina
  • Prerenal - Hypovolemia, decreased cardiac output, decreased vascular resistance (sepsis), renal vasoconstriction
  • Renal - acute tubular necrosis - ischemia, nephrotoxic agents, inflammatory disease, rhabdomyolysis
  • Post-renal - acute urinary obstruction - ureteral stones, malignancy

ED and ICU Management of Hyperkalemia - William Knight, IV MD, University of Cincinnati
  • IV calcium gluconate, sodium bicarbonate, glucose/insulin
  • Nebulized albuterol other beta-adrenergic agonists
  • Sodium zirconium cyclosilicate, Patiromer sorbitex calcium, Sodium polystyrene sulfonate
  • Hemodialysis

Advanced Circulatory Management to prevent and treat AKI - Jordan Bonomo, MD, University of Cincinnati
  • Fluid, pressors, and other pharmacologic treatments for heart failure
  • Setting up hemodialysis in your ED and ICU
  • Accessory cardiovascular support – LVAD
  • ECMO

Optimizing Oxygenation in Critical Illness - Brian Fuller, MD, Washington University, St. Louis
  • Initial ventilator management for emergency physicians

Using Oral Binding Agents in the Management of Hyperkalemia in the ED and Critical Care Setting – W. Frank Peacock, MD, Baylor College of Medicine

  • Treatment of hyperkalemia in the emergency department: What is the standard?
  • Review of sodium polystyrene, patiromer, sodium zirconium cyclosilicate

Accreditation Information

Joint Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Cincinnati Office of Continuing Medical Education, EMCREG-International and TotalCME, Inc.

The University of Cincinnati is accredited by the ACCME to provide continuing medical education for physicians. The University of Cincinnati designates each live activity for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credits commensurate with the extent of their participation in the activity.

Speaker Disclosures

In accordance with the ACCME Standards for Commercial Support of CME, the speakers for this course have been asked to disclose to participants the existence of any financial interest and/or relationship(s) (e.g., paid speaker, employee, paid consultant on a board and/or committee for a commercial company) that would potentially affect the objectivity of his/her presentation or whose products or services may be mentioned during their presentation. The following disclosures were made:

Planning Committee Members

W. Brian Gibler, MD - Entegrion: Board Member, Advisor, Shareholder; EMCREG-International: Board Member, Shareholder
Bruce Gebhardt, MD - University of Cincinnati Reviewer - No relevant relationships
Susan P. Tyler - No relevant relationships
Barb Forney - No relevant relationships
Susan Diaz, Coordinator – No relevant relationships
Vinod Kalathiveetil, PharmD – No relevant relationships

Jordan Bonomo, MD – No relevant relationships
Rhonda Cadena, MD – No relevant relationships
Brian Fuller, MD – No relevant relationships
William Knight, IV MD – No relevant relationships
W. Frank Peacock, MD – Grants/research support recipient: AstraZeneca & Relypsa

Off-Label Disclosure Statement
Faculty members are required to inform the audience when they are discussing off-label, unapproved uses of devices and drugs. Physicians should consult full prescribing information before using any product mentioned during this educational activity.

Learner Assurance Statement
The University of Cincinnati is committed to resolving all conflicts of interest issues that could arise as a result of prospective faculty members’ significant relationships with drug or device manufacturer(s). The University of Cincinnati is committed to retaining only those speakers with financial interests that can be reconciled with the goals and educational integrity of the CME activity.


The opinions expressed during the live activity are those of the faculty and do not necessarily represent the views of the University of Cincinnati. The information is presented for the purpose of advancing the attendees' professional development.

Fee Information
There is no fee for these educational activities.

A statement of credit will be issued only upon receipt of a completed activity evaluation form and will be emailed to you within three weeks.


This activity is supported in part by an independent educational grant from AstraZeneca.
Jointly provided by University of Cincinnati College of Medicine Office of Continuing Medical Education, EMCREG-International, and TotalCME.


Jordan B. Bonomo, MD, FCCM
Associate Professor, Emergency Medicine, Neurology, Neurosurgery and Neurocritical Care
Program Director, Neurocritical Care Fellowship
Director, Division of Critical Care, Department of Emergency Medicine
Associate Director for Education and Program Development, Neuroscience Intensive Care Unit
University of Cincinnati
Associate Medical Director, LifeCenter Organ Donor Network (
Cincinnati, OH

Rhonda Cadena, MD
Interim Division Chief, Neurocritical Care
Director, Neurocritical Care Fellowship
Departments of Neurology, Neurosurgery, and Emergency Medicine
University of North Carolina Hospitals
Chapel Hill, NC

Brian Fuller, MD, MSCI, FCCM
Associate Professor of Anesthesiology & Emergency Medicine
Department of Anesthesiology, Division of Critical Care
Department of Emergency Medicine
Washington University School of Medicine in St. Louis
St. Louis, MO

W. Brian Gibler, MD FACEP, FACC, FAHA
President, EMCREG-International
Professor of Emergency Medicine
Director of Business Development
Department of Emergency Medicine
University of Cincinnati College of Medicine
Cincinnati, OH

William A. Knight, IV MD
Associate Professor - Emergency Medicine, Neurology & Neurosurgery
Medical Director – Emergency Medicine Advanced Practice Provider Program
Associate Medical Director – Neuroscience ICU
University of Cincinnati
Cincinnati, OH

W. Frank Peacock, MD, FACEP, FACC, FESC
Professor, Vice Chair for Research
Henry JN Taub Department of Emergency Medicine
Baylor College of Medicine
Houston, TX