Sun28November0440PM 44

You are called to a normally fit and well 65-year-old patient on the medical assessment unit. He was admitted earlier in the day with pneumonia and fulfilled the criteria for severe sepsis.

Despite adequate fluid replacement over the course of the day his creatinine is 1200 µmol/L and his urea is 30 mmol/L.

Which of the following would be the most appropriate reason for initiating renal replacement therapy in this patient?

(Please select 1 option)

Drop in haemoglobin from 100 g/L to 74 g/L

Development of refractory fluid overload Correct

Development of pancreatitis

pH of 7.35 despite fluid replacement

Potassium of 5.0 mmmo/L after optimal medical therapy

Explanation

The initiation of emergency renal replacement therapy is usually required for:

Acute life threatening hyperkalaemia which is resistant to treatment. In this example the potassium is within normal limits.

Development of metabolic acidosis which is non-responsive to fluid. In this instance the pH is within normal limits.

Development of fluid overload, which may manifest itself as pulmonary oedema.

Development of uraemia which may manifest itself as pericarditis (not pancreatitis), neuropathy and confusional state.

A drop in haemoglobin is not an indication for emergency renal replacement therapy. In this instance it maybe dilutional but sources of bleeding should be sought.

In chronic renal failure anaemia may result from a lack of erythropoietin production which can be treated with synthetic erythropoietin and iron infusion (not renal replacement therapy).

Reference:

UpToDate. Renal replacement therapy (dialysis) in acute kidney injury (acute renal failure) in adults: Indications, timing, and dialysis dose.

Answer Statistics

1

1%

2

96%

3

2%

4

1%

5

2%

Times answered: 350