Presentation
A 51-year-old male recently undergoing hemodialysis by a temporary dual lumen catheter presented fever. His catheter was removed, but he was admitted to the hospital presenting fever, decreased vision, edema, and pain in his left eye. [ncbi.nlm.nih.gov]
In one patient, gynecomastia was present before dialysis was started. Blood urea nitrogen and serum creatinine were the same in dialysis patients with gynecomastia as in the dialysis patients without gynecomastia. [annals.org]
The most common presenting symptoms are non-specific and may include nausea, vomiting, and abdominal pain. Other symptoms may be shortness of breath, chest pain, back pain and headaches. [link.springer.com]
Presentation on theme: "DR SANJIV MAHAJAN Complications of hemodialysis and their management. [slideplayer.com]
Entire Body System
-
Gangrene
Mild cases can be observed closely, as most of them will reverse in a few weeks; however, severe cases require immediate intervention to prevent severe ischemic complications including ischemic neuropathy and ischemic gangrene with the potential need [advancedrenaleducation.com]
Respiratoric
-
Hoarseness
[…] suffer hoarseness (n 51). [ncbi.nlm.nih.gov]
-
Aspiration
Management of Air Embolism • Clamp venous line; stop blood pump • Place pt in left lateral position, with head & chest down • Administer 100% O2 (enhances nitrogen diffusion out of air bubbles), cardiopulmonary support as necessary • Rarely, percutaneous aspiration [slideshare.net]
-
Productive Cough
cough 30 Pyrogenic Reaction Fever reaction due to presence of dead bacteria endotoxins Low molecular weight endotoxin fragments may be able to cross any membrane, irrespective of membrane pore size distribution Caused by contamination of: Bicarbonate [slideplayer.com]
Liver, Gall & Pancreas
-
Asterixis
Early findings include Headache Nausea Disorientation Restlessness Blurred vision Asterixis More severely affected patients progress to confusion, seizures, coma, and even death. 24. [slideshare.net]
Skin
-
Skin Atrophy
Prolonged bleeding may also be caused by excessive heparinization of the blood circuit, access laceration during previous cannulation or skin atrophy 15. [advancedrenaleducation.com]
-
Cold, Clammy Skin
clammy skin (diaphoresis) Nausea/Vomiting Cramping Chest pain/angina Yawning, feeling dizzy, sleepy or weak Pallor Decreasing mental status to loss of consciousness Seizure 11 Treatment of Hypotension Treat the symptoms Pay attention to how the patient [slideplayer.com]
Eyes
-
Conjunctival Hyperemia
On examination, eyelid edema, conjunctival hyperemia, purulent secretion, hypopyon in the pupils, and visual acuity of NLP were verified. [ncbi.nlm.nih.gov]
-
Corneal Infiltrate
She was admitted to the hospital presenting pain, proptosis, conjunctival hyperemia, corneal infiltrate, and visual acuity of no light perception (NLP). [ncbi.nlm.nih.gov]
Neurologic
-
Slurred Speech
speech Seizure and coma 18 Cause of Disequilibrium Syndrome Causes Slower transfer of urea from the brain tissue to the blood Fluid shift into the brain due to removal of wastes from the blood stream causing cerebral edema Rapid changes in serum [slideplayer.com]
-
Lethargy
A cause of these symptoms is the dialysis disequilibrium syndrome, which may be manifested by confusion, headache, hypertension, convulsions, coma and even death. 1 Confusion, lethargy and coma followed by death have also been reported 2 to result from [nejm.org]
Workup
Given the patient’s elevated myoglobin, which peaked at 3,101 ng/ml, a rheumatologic workup was ordered and found to be normal. [link.springer.com]
Treatment
When suspected, urgent ophthalmologic evaluation and treatment are needed to reduce the risk of losing vision in the affected eye. [ncbi.nlm.nih.gov]
speech/mental changes Prevention: Assess new patients electrolyte levels Use a smaller dialyzer, lower BFR and shorter dialysis time for first few treatments 20 Nausea and Vomiting Causes: Hypotension Uremia Disequilibrium Syndrome Treatment [slideplayer.com]
Prior to starting your dialysis treatment the dialysis staff will weigh you, and calculate how much weight you gained since the previous dialysis treatment when you left (dry weight). [verywell.com]
Prognosis
Dialysis pericarditis, endocarditis Endocarditis – S.aurueus, 20%, poor prognosis, ageing valve calcification B) Gastrointestinal Complications 1. [epomedicine.com]
Powe NR, Jaar B, Furth SL, Hermann J, Briggs W (1999) Septicemia in dialysis patients: inci-dence, risk factors and prognosis. Kidney Int 55: 1081-1090. [omicsonline.org]
There is a significantly increased risk of infectious complications, thrombosis, and other complications associated with CVC use which negatively affects patient prognosis [ 4 ]. [journals.plos.org]
Etiology
Although the etiology has not been established, recurrence can be prevented by selection of a different type of dialysis membrane. [ncbi.nlm.nih.gov]
You instruct the patient to continue holding firm pressure and consider possible etiologies of the bleeding. [emdocs.net]
In our study, we have identified a large predominance of multi-resistant bacteria that etiology would be probably multifactorial like self-medication of some patients, immunodepression and the level of hospital hygiene precisely the lack of some materials [omicsonline.org]
Data recorded at the time of initiating dialysis included age, gender, primary etiology of ESRD, presence of co-morbid diseases (diabetes, hypertension, cardiovascular disease, chronic heart failure [New York Heart Association {NYHA} stage III-IV], cerebrovascular [journals.plos.org]
Epidemiology
In light of recent investigations suggesting that intradialytic hypertension is associated with adverse outcomes, this review broadly covers the epidemiologic characteristics, prognostic significance, potential pathogenic mechanisms, prevention, and possible [ncbi.nlm.nih.gov]
Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore USA 4. Welch Center for Prevention Epidemiology and Clinical Research, Johns Hopkins Medical Institutions Baltimore USA 5. [link.springer.com]
Katneni R, Hedayati SS (2007) Central venous catheter-related bacteremia in chronic hemodial-ysis patients: epidemiology and evidence-based management. Nat ClinPractNephrol 3: 256-266. [omicsonline.org]
2 ERA-EDTA registry Academic Medical Center Amsterdam Netherlands Marion Verduijn Marion Verduijn 1 Department of Clinical Epidemiology Leiden University Medical Center Leiden Netherlands Friedo Dekker Friedo Dekker 1 Department of Clinical Epidemiology [academic.oup.com]
Epidemiology of kidney disease in the United States. 2015. Available from: Dhingra R, Young E, Hulbert-Shearon T, Leavey S, Port F. Type of vascular access and mortality in US hemodialysis patients. Kidney Int. 2001; 60(4):1443-1451. [emdocs.net]
Pathophysiology
However, further work is necessary to elucidate the pathophysiologic mechanisms of intradialytic hypertension and its appropriate management and determine whether treatment of intradialytic hypertension can improve clinical outcomes. [ncbi.nlm.nih.gov]
The pathophysiological basis of this condition is a marked decrease or reversal of flow in the arterial segment distal to the AVF or AVG, induced by the low resistance of the fistula outflow 11. [advancedrenaleducation.com]
However, still little is known about prediction and the pathophysiologic mechanisms leading to CVD. [academic.oup.com]
Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol. Psychiatry 65, 732–741 (2009). 94. Serebruany, V. L. et al. [nature.com]
Prevention
In light of recent investigations suggesting that intradialytic hypertension is associated with adverse outcomes, this review broadly covers the epidemiologic characteristics, prognostic significance, potential pathogenic mechanisms, prevention, and possible [ncbi.nlm.nih.gov]
[…] cause/s of each The signs and symptoms of each The management and intervention of each Special attention to: Disequilibrium syndrome Hypotension Air embolism 3 Problems and Complications Monitoring during the dialysis treatment is done to prevent [slideplayer.com]
It is important to gain information about early clinical symptoms of AVF dysfunction in order to prevent and adequately treat potential complications. [laminatemedical.com]
To prevent transmission, the Centers for Disease Control and Prevention (CDC) has recommended that all patients and personnel in dialysis units receive hepatitis B vaccine. [quizlet.com]