A 74-year-old female long-known with hypertensive heart failure and chronic fluid overload has CKD stage 3 with a serum Cr 204 umol/l (2.3 mg/dl). She rapidly gains 8–10 kg within a 4-week period necessitating admission to ICU due to pulmonary oedema. Fortunately, she continues to pass urine volumes of more than 2 liters per day and has no metabolic derangements necessitating dialysis. A trial of progressive escalation of diuretic dose with a sequential nephron blockade is implemented. On day 3after 3 kg of weight loss, she was still on 4 L nasal cannula and her chest X Ray showed mild improvement of her pulmonary edema, her the serum Cr starts to rise (204 (2.31) to 267 umol/l (3.02 mg/dl)). Her serum K is 3.9 meq/L.
What is the CORRECT course of action to facilitate an ideal renal and cardiac outcome?
A) Stop all attempts at further diuresis and permit fluid overload as the lesser of two evils.
B) Reduce sequential nephron blockade dosing strategy to reduce the speed of decongestion.
C) Continue the course of decongestion until an acceptable dry weight is achieved.
D) Prepare the patient for maintenance dialysis therapy.
