Pass Medicine 33

Question 5 of 71   A 60 year old male with stage 5 chronic kidney disease developed a sudden attack of nausea and sweating during a session of hemodialysis. He was on a 3 times a week hemodialysis schedule. Routine checks prior to starting dialysis showed a weight of 74 Kg (dry weight 70 Kg), Blood pressure 160/90 mmHg, pulse rate 90/min, moderate bilateral oedema and fine bilateral basal inspiratory crackles. Blood investigations were as follows: Hb 93 g/l Platelets 300* 109/l WBC 9* 109/l Na+ 140 mmol/l K+ 5.5mmol/l Urea 32 mmol/l Creatinine 294 µmol/l Dialysis was started through an arterio-venous fistula. After 45 minutes, the patient developed nausea and sweating. Blood pressure was 100/70 mmHg and pulse rate was 105/min. Blood sugar was 6.5 mmol/l. What is the first step in management? Stop ultrafiltraion Give normal saline 200 ml (rapid infusion) Stop the dialysis machine Do an ECG and transfer to cardiac care unit Give metoclopramide The patient developed acute hypotension due to the high ultrafiltration rate of the dialysis machine. Although the amount of ultrafiltration is not mentioned in the question a candidate should always suspect this in such a scenario when the patient weight is high above his dry weight. Usually, the ultrafiltration  Rate. discuss and give feedback on this question Next question  Renal replacement therapy The timing of starting renal replacement therapy (RRT) in patients with end-stage chronic kidney disease (CKD) remains controversial. Patients usually begin dialysis when their glomerular filtration rate (GFR) reaches 10 ml/minute or 15 mL/minute if they are diabetic.2%   . Although giving an anti-emetic may relieve symptoms we should always seek the underlying cause and not treat symptoms blindly. 200 ml normal saline could be given.amount would be set before starting dialysis to remove any additional weight above the dry weight. discuss and give feedback on this question  Discuss. dialysis should be stopped. An ischaemic event should also be suspected in such a patient but there is no mention of chest pain or shortness of breath in the question.  Rate. If this is of no benefit. correct and update the 'Renal replacement therapy' notes Next question           Save my notes Question stats A 32.6% B 19% C 22. If the patient remains hypotensive even after stopping ultrafiltration. co.uk/#q=Renal replacement therapy ) Dashboard Overall score: 60% 1 2 3 4 5 All contents of this site are © 2015 Passmedicine Limited Back to top .google.2% E 6% 32./review/textbook.6% of users answered this question correctly Search Passmedicine Search term Go  Open MRCP Part 2 Written textbook (..D 20.php) External links + Suggest a link  Google search on "Renal replacement therapy" (https://www.