Diferencia entre revisiones de «Dysequilibrium syndrome»
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[[Category:Neurology]] | |||
Revisión del 04:28 16 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
References
- Mailloux L, et al. Dialysis Dysequilibrium Syndrome. UpToDate. Waltham, Mass.: UpToDate; 2017. www.uptodate.com. Accessed April 13, 2017.