#1
THE ANSWER IS C.
Although the decision to institute dialysis in a patient with chronic kidney disease (CKD) is complicated, the indications for emergency dialysis are not. Pulmonary edema represents one of the most common problems patients with CKD present with to the Emergency Department. Patients will typically have worsening dyspnea on exertion or shortness of breath but body weight significantly greater than “dry weight” may be the best indicator. Initial emergency treatment of pulmonary edema in the dialysis patient mimics the treatment in the non-dialysis patient. Supplemental oxygen should be given and nitroglycerin (sublingual or intravenous) started. Regardless of response to these interventions, arrangement for dialysis should be made. Dialysis is the most effective approach to reducing circulating volume when the patient lacks kidney function. Medical treatment may temporarily stabilize a patient while awaiting dialysis. Other emergent indications for dialysis include severe uncontrollable hypertension, hyperkalemia, severe electrolyte or acid-base disturbance, specific overdoses and severe, symptomatic uremia.
Hyperphosphatemia, not hypophosphatemia (A), is a trigger for dialysis. Patients may miss a scheduled dialysis treatment (B) without developing complications requiring emergent dialysis. Severe uremia without symptoms (D) does not require emergent dialysis. However, the presence of symptoms including altered mental status or bleeding would qualify the patient for emergent dialysis.
Reference
Wolfson AB. Renal Failure; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 97: p 1291-1313.
