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A 55-year-old man undergoing hemodialysis three times a week missed his previous dialysis 2 days ago and presents to the emergency department, concerned about his missed dialysis. He is without specific complaints, except stating that he is several pounds over his dry weight. His vitals signs reveal that he is afebrile at 36.5°C, heart rate is 80 beats/minute, respiratory rate is 14 breaths/minute, and blood pressure is 130/80 mm Hg. He has no jugular venous distension. His lungs are clear, and his heart sounds are regular with no S3 gallop or murmur. He has 1+ peripheral edema. His chemistry profile shows Na+ 138 mEq/L, K+ 5.8 mEq/L, Cl- 104 mEq/L, HCO3- 22 mEq/L, blood urea nitrogen 120 mg/dL, creatinine 7.0 mg/dL, and glucose 125 mg/dL. An ECG performed because of hyperkalemia is normal.
Which of the following is an indication for emergent hemodialysis in this patient?
a) Hyperkalemia
b) Elevated blood urea nitrogen
c) Elevated creatinine
d) Metabolic acidosis
e) None of the above
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i think its A because it has a potential life threatning complication but metabolic acidosis is an indication as well. Can someone plz explain as between A and D. Thanks
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i would go with elevated serum creatinine which indicates that this patient has reduced creatinine clearance due to missed dialysis and his kidney are screwed. He needs urgent dialysis in order to prevent the development of uremic encephalopathy. Elevated BUN can occur due to multifactorial causes. His HCO3 is 22, so he is not in metabolic acidosis. though his serum K+ is slightly high, has not caused any ECG changes and no symptoms of hyperkalemia. So His elevated creatinine is an indication for serious kidney damage and need for emergent dialysis.
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The correct answer is A.
Hyperkalemia is more dangerous!!...the patient can go to cardiac arrest.This knowledge is used to complete the sentence of the death penality's people. Metabolic acidosis is less serious (even though it can a cause of Hyperkalemia), respiratory compensation will be there for this patient.
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clinically, k=5.8, u have many way to bring down k level, but not with cr.
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I found the answer to that question on-line let me copy/past it for you guys...we are out!!...but we gave it a nice try...lol...Raheem where did you find that question?...Is it from NBME?
Answer and Discussion
The answer is e. Indications for emergent hemodialysis should not be based on the value of blood urea nitrogen or creatinine levels. Indications for emergent hemodialysis include symptomatic uremia (including pericarditis, neuropathy, or unexplained alterations in mental status), significant fluid overload, refractory hyperkalemia, or refractory metabolic acidosis. This man is neither symptomatic from uremia nor significantly fluid overloaded. Furthermore, his ECG does not demonstrate changes typically seen with significant hyperkalemia (he may have a baseline K+ of 5.5 mEq/L). His metabolic acidosis is probably also near his baseline. He may need hemodialysis in the very near future, but not emergently
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ok... this explanation makes sense drguirand. Thanks.. so we need to know the indications for emergent renal dialysis.
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I think even platelet dysfunction due to uremia is an indication. Am I right?
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