Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders>>>>>Renal Replacement Therapy
Question 5#

In which of the following clinical scenarios is RRT LEAST likely to be urgently initiated?

A. 30-year-old female with postoperative acute renal insufficiency with serum magnesium >8 mEq/L with anuria and absent deep tendon reflexes
B. 50-year-old male with ESRD, on scheduled MWF dialysis, with serum potassium of 6 mEq/L
C. 45-year-old male with septic shock and anuric AKI on pressors with a PH of 7.0 and bicarbonate of 12 mEq/L
D. 60-year-old female with acute oliguric renal failure not responding to diuretic therapy with hypoxia and shortness of breath

Correct Answer is B

Comment:

Correct Answer: B

While hyperkalemia >6 mEq/L with ECG abnormalities is an absolute indication for RRT, asymptomatic hyperkalemia >6 mEq/L is only a relative indication, especially in a patient with ESRD. In the setting of AKI, metabolic acidosis with a pH <7.15, diuretic resistant fluid overload, and hypermagnesemia >8 mEq/L with anuria and absent deep tendon reflexes are absolute indications for RRT. In patients with AKI, refractory metabolic acidosis, diuretic resistant fluid overload, and hypermagnesemia >8 mEq/L with anuria are absolute indications for initiation of RRT.

References:

1. KDIGO clinical practice guidelines for acute kidney injury. Kidney Int Suppl. 2012;2(1). Chapter 5.1.
2. Gibney N, Hoste E, Burdmann EA, et al. Timing of initiation and discontinuation of renal replacement therapy in AKI: unanswered key questions. Clin J Am Soc Nephrol. 2008;3:876-880.