Indications for Acute Dialysis

Introduction

• Topic: Indications for acute dialysis
• Presenter: Surgery resident
• Context: Medicine's role in surgical residency
  • Surgery residents handle a lot of inpatient medicine
  • Important to know when to involve nephrology specialists

Purpose of the Lecture

• Big picture approach for medical students
  • Practical focus over theoretical knowledge
• AEIOU mnemonic for indications of acute dialysis

AEIOU Mnemonic

• A: Acidosis
• E: Electrolytes
• I: Ingestion (rarely discussed in surgery context)
• O: Overload (fluid)
• U: Uremia

Acidosis (A)

• Objective Assessment: Lab values
  • Basic metabolic panel for bicarb levels
  • VBG or ABG for pH, base excess, CO2
• Signs: Respiratory compensation, accessory muscle use
  • Negative base excess indicates acidosis

Electrolytes (E)

• Focus: Potassium
  • Labs for potassium levels
  • EKG to monitor heart (peak T waves, widened QRS, sine wave for arrest)
• Management:
  • Stabilize: Calcium
  • Shift Potassium: Insulin & dextrose, albuterol, bicarbonate
  • Remove Potassium: Diuretics, KXLY

Ingestion (I)

• Rarely a focus in surgical context

Overload (Fluid) (O)

• Objective Data:
  • Daily weights
  • Chest X-rays (pulmonary edema)
  • Urine output
• Physical Exam: Crackles in lungs, edema, JVP
• Symptoms: Increased oxygen requirement, hypoxia
  • Managed with diuretics or fluid restriction initially

Uremia (U)

• Measurement: Elevated BUN (labs)
  • Levels above 80–100
• Symptoms: Altered mental status, itching, nausea, vomiting, headache, bleeding
  • Bleeding due to platelet dysfunction, treatable with DDAVP

Conclusion

• Summary of A-E-I-O-U mnemonic
  • Acidosis: Hydrogen ions
  • Electrolytes: Potassium
  • Ingestion: Not discussed in detail
  • Overload: Fluid levels
  • Uremia: Elevated BUN
• Practical Assessment: Combine objective data (labs, EKG, daily weights) and physical examination for effective decision-making on dialysis
• Reminder: Educational purposes only