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These signs indicate the situation has moved beyond self-management: Inability to keep any fluid down for more than 12-24 hours Urine output dropping to less than 400 mL in 24 hours (oliguria) Confusion, excessive sleepiness, or inability to stand without dizziness Serum creatinine rise of 0.3 mg/dL or more above baseline (meeting KDIGO AKI criteria) Resting heart rate above 120 beats per minute The National Kidney Foundation's KDIGO 2012 AKI guideline defines AKI stage 1 as a serum creatinine increase of 0.3 mg/dL within 48 hours or a rise to 1.5 times baseline within 7 days [10]