Sick Day Rules CKD — ESENeph MCQ

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HardAcute Kidney InjurySick Day Rules CKDESENeph

A patient with CKD develops shock, pH 6.92 and lactate 16 mmol/L while taking metformin. AKI is severe and the acidosis persists despite resuscitation. What is the most appropriate renal intervention?

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Correct answer: E — Urgent extracorporeal treatment

Severe metformin-associated lactic acidosis with shock, profound acidemia and renal failure is an indication for urgent extracorporeal treatment while the underlying illness is resuscitated. Intermittent haemodialysis efficiently corrects acidosis and removes metformin when haemodynamics permit; continuous therapy may be used when instability prevents it. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: NICE NG148: Acute kidney injury. https://www.nice.org.uk/guidance/ng148/chapter/recommendations; MHRA and UK Kidney Patient Safety Committee: Dialysis guidance. https://www.gov.uk/government/publications/dialysis-guidance/dialysis-guidance