Dialysis...
...
or not to Dialysis?
100

30yoM w/ denied pmhx, reports overdose on salicylates. Labs resulted with Salicylate level of 80 w/ normal Cr, BUN and GFR. Dialysis?

No

  • If [salicylate] > 7.2 mmol/L (100 mg/dL) (1D)

  • If [salicylate] > 6.5 mmol/L (90 mg/dL) in the presence of impaired kidney function (1D)

  • In the presence of altered mental status, seizure

  • In the presence of new hypoxemia requiring supplemental oxygen, Pulmonary edema

  • If standard therapy (supportive measures, bicarbonate, etc.) fails (1D)

100

50yoM w/ pmhx of afib and CHF presents  to the ED w/ nausea vomiting vision changes (described as yellow halos). EKG showing multiple PVCs. Should we dialysis?

No, not recommended

Use, Digoxin-fab Complex/antibodies 

200

30yoF w/ denied pmhx reported TCA overdose. Patient reports some nausea vomiting and abdominal pain. Dialysis

No, Dialysis is not recommended

200
25yoF w/ pmhx of DM presents to the ED with metformin overdose. Labs show ALT >1000, AST >1000, elevated PT/INR/PTT. Dialysis

Yes, Dialysis

  • Comorbid contions that lower the threshold for ECTR initiation

    • Shock

    • Impaired kidney function

    • Liver failure

    • Decreased level of consciousness (2D)

300

30yoM presents to the ED after found with acute onset blindness. Wife at bedside states that he is into beer making and has been drinking his homemade beer. 1st line antidote is unavailable. Dialysis?

Yes, Dialysis 


300

40yoM presents to the ed for TCA overdose. EKG shows mild widening of QRS. Pt showing signs of anticholinergic syndrome of tachycardia and elevated temp. Sodium Bicarb is given. Dialysis 

No, not recommended

400

25yoF presents to the ed sp ethylene glycol intake. Labs show Ethylene glycol levels of 60, after fomepizole admin, levels decrease to 55. Dialysis?

Yes, Dialysis

Fomepizole is used: we suggest dialysis if EG concentration is > 50 mmol/L 

No antidote is available: We recommend dialysis if EG concentration is > 10 mmol/L (> 62 mg/dL)

400

40yM w/ pmhx of HTN presents to the ED for hypotension and bradycardia and normal finger stick glucose. Pt reports accidentally taking multiple doses of medication. Dialysis 

Dialysis is not recommended for CCB overdose

500

55yoM w/ psych hx of bipolar and CHF presents to the ED for lithium overdose. Patient reports shortness of breath and acute bilateral pitting edema. US showing Blines in bilateral Lung fields. Labs showing Li level of 4. Dialysis? 

Yes dialysis

- Li >5 mEq/L

- Li >4 mEq/L + renal insufficiency 

- AMS Altered Mental Status

- Seizure

- life-threatening complications regardless of their lithium level

- symptomatic patients who are unable to tolerate aggressive hydration

500
25yoM presents to the ED for Valproic Acid overdose. Pt is aaox3 gcs15 but with difficulty walking and speaking. CT head shows cerebral edema. Dialysis?

Yes, Dialysis is recommended

  • If the [VPA] is > 1300 mg/L (9000 μmol/L) 

  • If shock is present 

  • If cerebral edema is present 

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