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Dialysis Indications

Topic updated on 09/03/17 11:31pm

Snapshot
  • A 57-year-old woman with a history of acute myeloid leukemia (AML) develops symptoms of significant muscle weakness and vomiting after the administration of her chemotherapy regimen. She has diffuse muscle weakness on physical exam. Serum electrolyte studies reveal a potassium level of 6.9 mEq/L. An electrocardiogram (EKG) shows peaked T waves, a prolonged PR interval, and a widened QRS complex. She is given intravenous (IV) calcium gluconate, insulin with glucose, bicarbonate, and sodium polystyrene sulfonate. However, repeat serum potassium is 6.6 mEq/L and a repeat EKG shows sine waves. (Hyperkalemia)

Overview
  • Mnemonic AEIOU - indications for dialysis
    • Acidosis
      • metabolic acidosis with a pH < 7.1
    • Electrolytes
      • hyperkalemia > 6.5 mEq/L refractory to treatment or rapidly rising levels in potassium
    • Intoxications
      • with dialyzable drug, including 
        • salicylates, lithium, isopropanol, methanol, and ethylene glycol (SLIME)
    • Overload
      • volume overload that does not respond to diuresis
        • especially with increased oxygen requirements
    • Uremia
      • elevated BUN with signs of uremia, such as
        • uremic bleeding, encephalopathy, pericarditis, and neuropathy
  • Serum creatinine > 10 mg/dL

 

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