This was a small retrospective review from Swansea looking at 278 patients who attended a teaching hospital Accident and Emergency department with a diagnosis of epistaxis. Only 119 of these patients had their serum urea measured. The investigators found that the mean serum urea level was significantly higher in those patients who were admitted than those patients who were discharged (even when those patients with elevated serum creatinine were excluded). There was however no significant difference in serum urea levels for those patients who did or didn’t undergo transfusion or surgical intervention. The reasoning for acute severe epistaxis causing elevated serum urea levels is due to increased ingestion of blood and possible pre-renal failure due to hypovolaemia. Elevated serum urea levels may be expected in patients with epistaxis and will not be a sole deciding factor in whether to admit or not. Nevertheless the message of this study is the potential use of serum urea in a scoring system for prognostic information regarding epistaxis severity, similar to that used for upper gastrointestinal bleeding.

The relationship between serum urea levels and outcome in acute epistaxis.
Fishpool SJC, Foley K, Bull S, Whittet H.
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Sunil Sharma

Alder Hey Children's Hospital, UK.

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