SHM Converge Scientific Abstract ePoster Gallery-Finding Frost in Houston

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This case describes a 34-year-old man with hypertension, hyperlipidemia, obesity, type 2 diabetes, and end-stage renal disease who had stopped attending hemodialysis for several months and was unable to afford medications. He presented with dyspnea, volume overload, and confusion. On exam, he was lethargic, hypertensive, edematous, and had striking white crystalline deposits on his forehead, eyebrows, and nose consistent with uremic frost. Labs showed severe renal failure and metabolic derangements, including hemoglobin 5 g/dL, potassium 5.9 mEq/L, BUN 168 mg/dL, creatinine 21.1 mg/dL, and phosphorus 10.9 mg/dL.<br /><br />He received emergent hemodialysis in the emergency department and then underwent three dialysis sessions over five days. His BUN improved to 45 mg/dL, his confusion resolved, and the facial crystals disappeared. He was discharged in stable condition with placement at a new hemodialysis facility.<br /><br />The discussion reviews uremic frost, a rare dermatologic sign of severe uremia that was more common before widespread hemodialysis. It results from high serum urea levels that accumulate in the skin and crystallize as sweat evaporates. It typically appears on areas with more pilosebaceous units, such as the face, neck, scalp, forearms, and chest, and is usually associated with very high BUN levels. Diagnosis can be confirmed by scraping crystals for urea content. The condition should prompt urgent dialysis, and skin findings generally resolve completely once renal dysfunction is corrected.

Asset Subtitle

Risheng Xu

Meta Tag

Author List James Liu, Joslyn Fisher, Risheng Xu, Saleem Shamsee

Category Clinical Vignettes

Concept Uremic Frost

Concept Uremia

Concept End-stage Kidney Disease

Concept Hemodialysis

Concept Blood Urea Nitrogen

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Risheng Xu

Track Adult

Keywords

uremic frost

end-stage renal disease

hemodialysis

uremia

renal failure

volume overload

metabolic derangements

hyperphosphatemia

confusion

dialysis

Uremic Frost

Uremia

End-stage Kidney Disease

Hemodialysis

Blood Urea Nitrogen