🩸💥 When CRRT Heals… but Slowly Hurts—Will You Notice the Dialy-Trauma? 💥🩸

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Q1. A 62-year-old trauma patient on CRRT for rhabdomyolysis-associated AKI has normal serum phosphate (2.6 mg/dL), worsening respiratory acidosis, and diaphragmatic excursion on POCUS. You are already giving 1.5 g/kg/day protein via EN. What’s the most appropriate response?
Q2. A 45-year-old with recovering septic shock on CRRT and broad-spectrum antimicrobials shows rising creatinine kinase and prealbumin decline. You are delivering 1.2 g/kg/day of protein, and enteral nutrition is 75% goal. The effluent nitrogen loss is high. What should you do next?
Q3. A patient with vasoplegic shock on CRRT is being considered for switch to SLED. He is on norepinephrine 0.06 µg/kg/min with a MAP of 67 mmHg. ScvO₂ is 58%, and perfusion indices are borderline. What should guide your next step?
Q4. A CRRT patient shows persistent mild hypothermia (35.2°C), normal lactate, and stable hemodynamics. You’re already using a warming blanket. Nursing raises concerns about continuing ultrafiltration. What is your best approach?
Q5. A 68-year-old cirrhotic patient with ACLF on CRRT shows total calcium 10.8 mg/dL, iCa 0.9 mmol/L, and a pH of 7.53. You suspect citrate accumulation. The current calcium infusion rate is 3 mL/h. What’s your next step?
Q6. A 50-year-old burns patient on high-dose CRRT (35 mL/kg/h) develops persistent hypoglycemia and elevated lactate despite adequate feeding. There are no signs of sepsis or insulin overdose. What’s the most plausible intervention?
Q7. A CRRT patient in negative fluid balance develops cold extremities, prolonged CRT, and borderline MAP despite unchanged vasopressors. Dynamic fluid tests are unreliable due to arrhythmia. What’s your best approach?
Q8. Despite 2.2 g/kg/day protein delivery and preserved gut function, a CRRT patient continues to have a fall in prealbumin and muscle wasting. CRRT dose is 30 mL/kg/h. What’s the most plausible contributor?
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