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Uraemic Frost as Terminal Sign — SCE Palliative Medicine MCQ

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HardNon-Malignant Palliative CareUraemic Frost as Terminal SignSCE Palliative Medicine

A patient with eGFR 4 mL/min has severe uraemic pruritus despite emollients and correction of reversible factors. Which systemic option is listed first line in the Scottish palliative guideline, with cautious renal dosing?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Gabapentin 140–300 mg daily with renal caution and review

The current Scottish guideline lists gabapentin 140–300 mg daily first line for uraemic pruritus, explicitly requiring caution in renal impairment. Naltrexone is later line; rifampicin and cholestyramine belong to cholestatic itch pathways, and antibiotics do not treat uraemic pruritus. Dose selection must account for accumulation, sedation and neurotoxicity.

Reference: Scottish Palliative Care Guidelines: Pruritus. https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/symptom-control/pruritis/