Answer: Medical emergencies by definition occur without warning. For people with a chronic illness, emergencies may be frequent. However, with proper planning, a sense of crisis can be avoided. For your convenience, a patient information sheet is provided on the next page. Examples of common emergencies in patients with renal failure include:

1. Sudden onset of fever and generalized weakness. The emergency room (ER) doctor will need to know whether you are under peritoneal dialysis (peritonitis) or hemodialysis (access infection) treatment, and are under treatment with an antibiotic (name and dose) or other medications.

2. Loss of consciousness. If an identification bracelet or necklace tells the ER staff that you have diabetes treated with insulin, a test dose of glucose (sugar) by vein – before lab reports your actual glucose value – could wake you up. Likewise, learning you are under treatment with powerful blood pressure reducing drugs and/or diuretics (which force excess salt and water into urine) could lead to a test trial of intravenous (IV) volume replacement with saline (salt solution) solving the problem. While a full workup is required for any unconscious patient, early clues given by the patient help solve the puzzle of what went wrong.

3. Chest pain. Knowing you have heart disease, particularly a problem with arteries that nourish the heart (coronaries), will direct attention to the heart rhythm record (electrocardiogram) and blood tests (enzymes) that indicate heart injury.

4. Missed dialysis treatment. Whether you “forgot” or were delayed by travel, a surprisingly common reason for kidney patients to appear in ERs is the need for dialysis at night, weekends or holidays. Dialysis units may be full with no room for “extra” or makeup dialysis. Be able to tell the date of your most recent dialysis and whether enough fluid was removed. Most hospitals can arrange for “urgent” dialysis, a task that is made easier if you are able to tell the dialysis staff your usual “dry” weight, the name and size of your dialyzer (you may not know this), the kind and length of your regular dialysis treatments, and what drugs are given to you during dialysis, such as heparin or erythropoietin (EPO), and their amounts. Also, know if you are allergic to any type or brand of dialyzer.

Because rapid response by the ER team can make a great difference in outcome, all information relating to key decisions should be easily available, especially when you are too sick to answer a lot of questions. This means you get ready to face the challenge of urgent care now, while you are well and able to think clearly. To help you prepare for your possible ER visit, use the patient information sheet included in this article. Click here to view the patient information sheet. (Adobe Acrobat required)

Collect needed documents in one corner of a desk or dresser drawer. Include your insurance card, copies of laboratory reports of radiology, blood and urine tests, as well as any special instructions detailing diet or regulation of known diseases, high or low blood pressure, anemia, or diabetes. Take time now to write down a simple list using the following guidelines:

1. Who your doctor may talk to about your illness and treatment progress. Unless you say so, your doctor is not allowed to give reports to anyone, not even your family, and especially not your employer.
2. Try to tell the story of your kidney illness. When did it begin? How was it first treated? Did you have a kidney biopsy (when, where, what was found)?
3. If you have diabetes, make certain you always wear a bracelet or necklace stating you have diabetes to alert the ER should you arrive in a coma.
4. Do you have limits in your care, such as vegetarian diet or no blood or blood product transfusion? Does your religion limit your behavior (seating by gender, no hand shaking, arms and legs covered, Halal meat)?

Writing to AAKP means that you realize AAKP stands ready to help. Strongly consider joining AAKP today, it can make a difference, especially finding out that you are not alone.

Answer provided by Eli A. Friedman, MD. Dr. Friedman is chief of the Division of Renal Disease for State University of New York, Downstate Medical Center and serves as chairperson of the AAKP Medical Advisory Board.

The Dear Doctor column provides readers with an opportunity to submit renal related health questions to healthcare professionals who specialize in the area of concern. The answers are not to be construed as a diagnosis and therefore, altercations in current healthcare should not occur until the patient's physician is consulted.

This article originally appeared in the September 2005 issue of aakpRENALIFE, Vol. 21, No. 2.

Back