QuestionSBA
QuestionChoice
NSAIDs should be avoided in such poor renal function and AKI, colchicine is recommended to be avoided in extremely low gfr (<10).
10035559
c
Administer NSAIDs and colchicine
QuestionChoice
NSAIDs should be avoided in such poor renal function and AKI. IVF will undoubtedly form part of the initial management of this patient but he needs acute dialysis.
10035561
e
Administer NSAIDs and intravenous fluids
QuestionChoice
This is correct. This patient has an acute kidney injury with features of pericarditis and encephalopathy, likely in the context of uraemia. He therefore needs acute dialysis. Other indications include refractory hyperkalaemia, acidosis, overload or toxin ingestion.
10035557
a
Refer for haemodialysis
QuestionChoice
There is no evidence of a Myocardial infarction at present. The ECG findings suggest pericarditis.
10035558
b
Refer for PCI
QuestionChoice
This is inappropriate as the patient is very unwell with uraemic pericarditis and encephalopathy.
10035560
d
Discharge with paracetamol
Concept
Chapter
2693
6142
Emergency management of Acute Kidney Injury (AKI)
Topic
142
Nephrology
19515
Indications for acute dialysis include severe electrolyte imbalances, acute kidney failure with significant fluid overload, uremic symptoms (such as encephalopathy or pericarditis), and poisoning or drug overdose that cannot be managed with other treatments.
A 35-year-old attends the emergency department with central chest pain, weakness and lethargy. It is difficult to elicit a history as he is confused. ECG shows widespread saddle-shaped ST elevation and PR depression. Troponin is raised. Urea and electrolytes reveal an eGFR of 8 mmol (>90), a creatinine of 300μmol (59 - 104) and urea of 26mmol (2.5-7.8)

What is the most appropriate management?
a