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Missed Dialysis Emergency — ESENeph MCQ

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EasyHaemodialysisMissed Dialysis EmergencyESENeph

A 65-year-old man on haemodialysis has the following bloods: K+ 6.8 mmol/L, bicarbonate 14 mmol/L, phosphate 2.4 mmol/L. His last adequate dialysis was 3 days ago. His residual urine output is <100 mL/day. He has been non-adherent with dialysis. What is the most important immediate action?

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Correct answer: B — Arrange urgent haemodialysis

This patient has missed dialysis sessions resulting in dangerous hyperkalaemia, acidosis, and hyperphosphataemia. With minimal residual renal function, he is dialysis-dependent and requires urgent haemodialysis for definitive electrolyte and acid-base correction. Potassium binders are adjunctive but cannot replace dialysis. IV calcium gluconate is a temporising measure but does not treat the underlying problem. Adherence counselling is important but secondary to the acute emergency.

Reference: KDOQI 2015 – HD Adequacy; UK Renal Association 2020