Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders>>>>>Renal Replacement Therapy
Question 6#

A 64-year-old female with ESRD and nonischemic cardiomyopathy with a left ventricular ejection fraction of 20% underwent IHD the day before. She developed flash pulmonary edema and is currently on epinephrine infusion for hemodynamic support.

Which of the following modalities would be MOST effective for fluid removal in this patient?

A. IHD
B. Slow continuous ultrafiltration (SCUF)
C. Intravenous furosemide
D. Continuous venovenous hemodialysis

Correct Answer is B

Comment:

Correct Answer: B

SCUF is used exclusively to remove fluids and therefore a useful modality to treat isolated fluid overload. SCUF is not useful in patients who are uremic or hyperkalemic, because solute removal is minimal. SCUF can safely remove up to 8 L of fluid per day. The slow rate of fluid removal is beneficial in patients who have a tenuous hemodynamic status.

References:

1. Granado R, Macedo E, Mehta R. Indications for continuous renal replacement therapy: renal replacement versus renal support. Critical Care Nephrology. 2019:987-993.e2:chap 163.
2. Ronco C, Ricci Z, Brendolan A, Bellomo R, Bedogni F. Ultrafiltration in patients with hypervolemia and congestive heart failure. Blood Purif. 2004;22(1):150-163.