Uremic frost is a classic manifestation of chronic renal failure; it is rarely seen today. It develops because of accumulation of urea in sweat. In advanced uremia, the accumulation may reach such a critical level that, upon its evaporation, a fine white powder is left on the skin surface. Associated hyperkalemia may also be present owing to concurrent renal failure.
Management and Disposition
Treatment of the underlying condition that resulted in the patient’s uremia may prevent further accumulation of uremic frost. Typically, urgent dialysis is indicated.
Although rare today, this condition may be seen in noncompliant patients or with environmental stressors, including inadequate air conditioning.
For patients presenting with altered mental status, attention to the airway, oxygenation, and rapid assessment and treatment of associated metabolic disorders, such as hyperkalemia, are paramount.
Uremic Frost. Note the fine white powder on the skin of this patient with end-stage renal disease. (Photo contributor: Alan B. Storrow, MD.)