II. Epidemiology

  1. Rare, but potentially lethal

III. Pathophysiology: Dialysis complication

IV. Symptoms

  1. Onset within 12 hours of Dialysis
  2. General
    1. Malaise
    2. Nausea or Vomiting
    3. Muscle cramping
  3. Cardiovascular
    1. Hypertension
  4. Neurologic
    1. Headache
    2. Motor Restlessness
    3. Confusion
    4. Altered Level of Consciousness
    5. Seizures

VI. Diagnostics

  1. Electroencephalogram (EEG)
    1. Diffuse metabolic encephalopathy

VII. Imaging

  1. MRI Brain (diffusion weighted)
    1. Osmotic demyelination of pons (and adjacent structures)

VIII. Management

  1. Seizure Prophylaxis
    1. Anticonvulsants
  2. Decrease cerebral edema
    1. Mannitol
    2. Hypertonic Saline

IX. Prevention

  1. Decrease initial Dialysis flow rate and duration (especially if high urea concentration)

X. References

  1. Glauser (2013) Crit Dec Emerg Med 27(10): 2-12
  2. Shaikh (2010) J Emerg Trauma Shock 3(3): 300 [PubMed]

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