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Hypoalbuminaemia Causing Peripheral Oedema — SCE Palliative Medicine MCQ

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HardPain ManagementHypoalbuminaemia Causing Peripheral OedemaSCE Palliative Medicine

A dying opioid-naive patient with eGFR 8 mL/min repeatedly benefits from alfentanil rescue doses. A CSCI is required with specialist supervision. Which example starting dose is given in the Scottish renal guideline?

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

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Correct answer: A — Alfentanil 500 micrograms/24 hours

Explanation lettering: E = shown as A · A = shown as B · B = shown as E

E is correct. The renal end-of-life guideline gives alfentanil 500 micrograms over 24 hours as an example pump starting dose for an opioid-naive patient, then titration to response. The guide also states that 1 mg alfentanil approximates to 30 mg oral morphine.

Reference: Scottish Palliative Care Guidelines: renal disease in the last days of life: https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/last-days-of-life-care-around-dying/renal-disease-in-the-last-days-of-life/