Diferencia entre revisiones de «Dysequilibrium syndrome»
| Línea 38: | Línea 38: | ||
*Limit the rate of urea removal during first few session of dialysis to prevent dysequilibrium syndrome | *Limit the rate of urea removal during first few session of dialysis to prevent dysequilibrium syndrome | ||
*For severe symptoms such as seizure, consider stopping dialysis | *For severe symptoms such as seizure, consider stopping dialysis | ||
==Disposition== | |||
*Most cases can be discharged with followup | |||
==References== | |||
Revisión del 01:48 14 abr 2017
Background
- Characterized by neurological symptoms that is thought to be secondary to cerebral edema affecting dialysis patients
- Tends to occur in patients who are initially started on dialysis, particularly with high initial BUN
- Symptoms are thought to be secondary to the development of cerebral edema possibly due to urea removal during dialysis and from a decreased in pH in the cerebral intracelluar environment
Clinical Features
- Signs and symptoms develop during or after dialysis or during renal replacement therapy, usually self limited but can occasionally progress
- Headache
- Nausea
- Visual disturbances
- Asterixis
- Altered mental staus
- Seizures
- Coma
- Muscle Cramps
Differential Diagonsis
- Hypoglycemia
- Hyponatremia
- Hypocalcemia
- Uremia
- Intracranial Bleed
- Hypertensive Emergency
- Stroke
- Supratheurapeutic Medication Effects
- PRES
Evaluation
- Clinical Diagonosis
- Bedside Glucose
- CBC
- Chem-10
- Liver Panel
- CT Brain
Management
- Supportive in most cases
- Limit the rate of urea removal during first few session of dialysis to prevent dysequilibrium syndrome
- For severe symptoms such as seizure, consider stopping dialysis
Disposition
- Most cases can be discharged with followup