30 yo M pmh ESRD 2/2 to lupus nephritis on HD p/w sob, tachypnea, and hypertensive not responding to Nitro gtt, lasix, or bipap.

what emergent procedure will most likely help this patient?

A:
Dialysis

what are the indications for Emergent Dialysis

Mneumonic for indications of Dialysis: AEIOU
1. Acidosis
2. Electrolyte abnormalities-hyperkalemia
3. Ingestion of substances like barbiturates, salicylates, lithium, methanlo, etc
4. Overload fluid (unresponsive to diuretics)
5. Uremia symptoms (pericarditis, encephalopathy)

 

The renal fellow comes down and states they can’t start HD for another five hours.

What else could you do?

Consider peritoneal dialysis.

 

References

http://www.uptodate.com/contents/acute-hemodialysis-prescription?source=search_result&search=EMERGENT+DIALYSIS&selectedTitle=2~150

http://navyemergencymedicine.com/wp-content/uploads/2010/05/Field-Peritoneal-Dialysis1.pdf

thanks Dr. Richardson, Dr. Pour

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