Obtundation or severe EKG changes in Chronic Renal Failure
- Classically seen where serum Cr exceeds 700 mmol/L ( 8 mg/dl
), or when acute episode of worsening renal failure is superimposed
on CRF patient (`acute-on-chronic').
- Dialysis usually indicated, especially if severe
hyperkalemia / acidosis present or patient already fluid overloaded.
- ( Exclude pseudohyperkalemia )
- emergency treatment often required if e.g. serum K > 7 mEq / L :
- Indications for Dialysisin Acute-on-Chronic Renal Failure
- (a) Any uremic symptoms (CNS, GI)
- (b) Any uremic signs (pericarditis, bleeding)
- (c) Serum creatinine over 700umol/L (8-10 mg/dl)
- (d) Hyperkalemia responding poorly to treatment
- (e) Severe acidosis
- (f) Severe fluid overload.
- In general, dialysis is performed early and
vigorously to allow patient to feel better, eat well. Don't wait for symptoms to
- Two types of dialysis available - Hemodialysis and Peritoneal
Hemodialysis is currently favored, especially in severely hypercatabolic patients.
(a) Easy and simple to perform - does not need special nurses or machines
(b) Does not require anticoagulation
(c) Associated with greater hemodynamic stability - can be used in hypotensive patients.
Disadvantages of peritoneal dialysis: -
(a) Protein losses through peritoneal membrane
(b) Risk of peritonitis
(c) Rather slow and inefficient dialysis
(d) Patient must be immobilized for prolonged periods.
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