106 - 110 SBAs for the Final FRCA
Question 106
A 56 year old man is in profound septic shock caused by pyelonephritis. He is intubated and requiring 0.6 mcg/kg/min of noradrenaline to maintain an adequate mean arterial pressure.
Despite medical management, his potassium is climbing and he is becoming fluid overloaded, so you decide to start him on the filter.
Which of the following is the best form of RRT to choose?
- SCUF
- CVVHDF
- IHD
- SLED
- CVVHF
Answer
- CVVHDF
Continuous veno-venous haemodialofiltration is the advised modality for haemodynamically unstable acute kidney injury.
- Slow continuous ultrafiltration is good for fluid removal but won't sort out the potassium effectively
- Intermittent haemodialysis causes huge osmolar shifts and likely won't be tolerated by this unstable patient
- Sustained low-efficiency dialysis is a hybrid technique used to help wean off continuous renal replacement therapy and is not suitable for acute management of severe renal injury
- Continuous veno-venous haemofiltration is reasonable but technically not as effective as having the added dialysate
You can read the full KDIGO guideline here if you feel so inclined.