Q: 47 year old male with CKD 3 is admitted to ICU with severe sepsis. Patient post-24 hours admission labs are relatively stable with creatinine rising from 1.2 to 1.4. Patient is on 'minimal dose' of norepinephrine. Patient is making about 15-30 cc/hr of urine. Patient's K is 5.2 mmol/L. You received call from lab that patient's Phosphate is 7 mmol/L. What would be your 'line of discussion' with nephrology service?



Answer: Possible initiation of CRRT 

Severe hyperphosphatemia is a sign that patient has developed acute on chronic renal failure despite 'reasonable' creatinine and potassium, and it would be appropriate to initiate renal replacement therapy. This is probably a sign that GFR has fallen below 20 to 25 mL/min. This is due to diminished phosphate excretion.