Outline the clinical scenarios in which you would consider instituting dialysis in the critically ill.

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College Answer

Dialytic techniques in the critically ill are becoming more widely used.  Traditional indications used for acute renal failure, are concerns about fluid overload (actual or to facilitate nutritional support), hyperkalaemia or other uncontrolled electrolyte disorders, metabolic acidosis, hyponatraemia, uraemic symptoms or elevated urea (e.g. 30 mmol/L).  As complications associated with techniques have been minimised, dialysis is often initiated earlier (anticipatory, oliguria, lower urea), and for non-renal indications (including sepsis or septic shock).   Dialysis or haemofiltration (e.g. with charcoal filter) can be used to increase the clearance of toxic products from the circulation (e.g. lithium, theophylline, myoglobin). Newer related extracorporeal techniques have also been developed to support liver dysfunction.

 

 

Discussion

This question is identical to Question 8 from the second paper of 2005.