Paweena Susantitaphong

Does this patient have intrdialytic hemolysis? Grossly translucent hemolyzed blood in the extracorporeal blood line Symptoms vary depending on causes and severity Causes MechanicalRelated Content High blood flow rate, single-needle dialysis, small-gauge cannula, kinked blood line, highly negative arterial pressure, offset blood pump Dialysate contamination Chloramine: dyspnea, cyanosis (methemoglobinemia, not improved by oxygen therapy), malaise,…

Does this patient have seizure? Focal or generalized seizure Causes Hyponatremia Hypoglycemia HypercalcemiaRelated Content Hypocalcemia Hypomagnesemia Uremic encephalopathy Dialysis disequilibrium syndrome Hard water syndrome (high calcium or magnesium in dialysate) Cerebrovascular accident (ischemic or hemorrhage) Subdural hematoma Malignant hypertension (hypertensive encephalopathy) Cerebral anoxia due to sustained hypotension Suboptimal anti-convulsant plasma level (removed during dialysis) Acute…

Does this patient have dialysis-induced headache? Symptoms Bifrontal discomfort (throbbing) Nausea with or without vomiting Aggravated by supine position No accompanying visual disturbances The International Headache Society (IHS) defines dialysis-related headache as a headache with no specific characteristics that develops during hemodialysis and resolves spontaneously within 72 hours of completion of the dialysis session. The…

Does this patient have dialysis disequilibrium syndrome? Symptoms Symptoms result from brain edema, varying from mild to severe: Headache Nausea with or without vomiting DizzinessRelated Content Muscle cramp Blurred vision Tremors Restlessness Agitation Alteration of consciousness Seizure Coma Sudden cardiac arrest Syndrome is usually mild, transient, and self-limited Symptoms develop during dialysis, immediately post-dialysis or…

Does this patient have muscle cramping? Symptoms Muscle cramping Restlessness AgitationRelated Content Anxiety What tests to perform? Clinical diagnosis Laboratory tests that may identify cause and assess severity: Serum magnesium (exclude hypomagnesemia) Serum calcium (exclude hypocalcemia) Serum creatinine kinase (may be elevated in severe form) (optional) Electromyography – increased tonic muscle electrical activity (optional) Bioelectrical…

Does this patient have dialysis-associated vascular steal syndrome? Symptoms (the classic 6 Ps) Pain Paresthesia Paralysis Pulselessness PoikilothermiaRelated Content Pallor Symptoms worsen during dialysis particularly in the setting of intradialytic hypotension, and during cold weather Signs Pallor Decreased sensation Diminished pulses Acrocyanosis Digital gangrene Differential diagnosis Dialysis-associated muscle cramp Diabetic or uremic polyneuropathy Entrapment neuropathy…

Does this patient have air embolism? Symptoms depend on amount, speed, and site of introduced air, as well as patient’s position Sitting position – venous emboli in cerebral circulation Seizure, coma Supine position Impaired right ventricular function (decreased cardiac output and hypotension)Related Content Microemboli to pulmonary vasculature (dyspnea, dry cough, chest tightness or pain, hypoxia,…

Does this patient have anaphylactic/anaphylactoid reaction? Symptoms and signs usually develop within first 5 minutes after starting dialysis Rhinorrhea Sneezing Coughing Lacrimation Burning or heat throughout body or vascular access site Related Content Flushing Pruritus Nausea/vomiting Abdominal pain Diarrhea Agitation Chest pain or chest discomfort Dyspnea Angioedema Laryngeal edema Paresthesias involving fingers, toes, lips, or…

Does this patient have intradialytic hypertension? Intradialytic hypertension is defined as an intradialytic increase in the systolic blood pressure by greater or equal than 10 mmHg or the mean arterial pressure by greater or equal than 15 mmHg. The hypertension usually develops during the second or third hour of hemodialysis after significant ultrafiltration has taken…

Does this patient have intradialytic hypotension? Intradialytic hypotension is defined as a systolic blood pressure of less than 100 mmHg or a systolic blood pressure decrease of greater than 10 mmHg, or a mean arterial pressure decrease of greater than 30 mmHg with or without symptoms. Symptoms result from decreased tissue perfusion, and vary in…