Which of the following is considered an absolute indication for initiating urgent dialysis rather than waiting for conservative measures?
- A Uraemic pericarditis with a friction rub ✓
- B Blood urea nitrogen of 90 mg/dL without symptoms
- C Creatinine clearance persistently below 15 mL/min
- D Metabolic acidosis with bicarbonate of 17 mEq/L responding to oral alkali
Explanation
The classic mnemonic AEIOU lists absolute indications: refractory Acidosis, symptomatic Electrolyte disturbance especially refractory hyperkalaemia, Intoxication with dialysable poisons, fluid Overload unresponsive to diuretics, and Uraemic complications. Uraemic pericarditis signals severe uraemic toxicity with risk of tamponade and mandates dialysis. An elevated urea alone, a low creatinine clearance, and mild acidosis responsive to medication are all relative or conservative-management situations. Timing of maintenance dialysis in asymptomatic patients follows symptoms and trajectory, not a fixed laboratory number.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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