Q:

Which of the following states is NOT an indication for renal replacement therapy (dialysis)?

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Which of the following states is NOT an indication for renal replacement therapy (dialysis)?


  1. Refractory metabolic acidosis.
  2. Oliguria.
  3. Severe hyperkalaemia.
  4. Uraemic symptoms.
  5. Drug ingestion.

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b. Oliguria is not an indication for dialysis itself and the cause should be investigated and treated, e.g. hypovolaemia. Manifestations of oliguria such as fluid overload refractory to treatment or build-up of toxins such as urea and nitrogenous compounds may, however, influence the decision to dialyse. A useful mnemonic for remembering the indications for dialysis is ‘AEIOU’ standing for Acidosis, Electrolyte abnormalities, Ingestions, Overload and Uraemic symptoms. Severe or worsening metabolic acidosis with a pH 7.2 and persistent hyperkalaemia 7mmol/L are good markers of the need for dialysis. Fluid overload, e.g. pulmonary oedema, that is likely to cause respiratory embarrassment and/or cardiovascular instability may be adequately managed with dialysis when medical therapy has failed. In the setting of acute overdose, especially with metabolic derangement as may be seen with aspirin overdose, dialysis can be a useful means of stabilising a patient until adequate acid–base homeostasis is achieved.

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