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| ==[[Dialysis-associated hypotension]]==
| | {{Dialysis complications DDX}} |
| ==[[Dialysis disequilibrium syndrome]]==
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| *Diagnosis of exclusion (r/o SDH, CVA)
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| *Clinical syndrome occurring at end of dialysis
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| **Occurs most commonly during initial dialysis or during hypercatabolic states
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| **Large solute clearances -> cerebral edema
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| *Symptoms
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| **N/V, HTN; can progress to seizure, coma, death
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| *Treat w/ mannitol
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| ==Air Embolism==
| | {{AV shunt complications DDX}} |
| *Acute dyspnea, chest tightness, LOC, cardiac arrest
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| *Treat w/ 100% NRB
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| ==Vascular Access Complications== | | ===Peritoneal Dialysis Complications=== |
| ===Thrombosis and Stenosis===
| | *[[Peritoneal dialysis-associated peritonitis]] |
| *Most common causes of inadequate dialysis flow | |
| **Loss of bruit and thrill over access
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| *Stenosis and even thrombosis are not emergencies
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| **Can be treated w/in 24hr by angiographic clot removal or angioplasty
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| **Thrombosis of vascular access can be treated w/ direct injection of alteplase 2.2mg
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| ***This therapy should be discussed with the vascular surgeon first
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| ===Infection===
| | {{ESRD Associated Skin Conditions}} |
| *Pts often p/w signs of systemic [[sepsis]] ([[fever]], [[hypotension]], leukocytosis)
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| **Classic signs of pain, erythema, swelling, d/c from infected access are often missing
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| *Dialysis catheter–related bacteremia is common and potentially life-threatening
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| **Give [[vancomycin]] 1gm IV +/- genamicin 100mg IV (if gram neg suspected)
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| **Do not remove dialysis patient's access
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| *Draw peripheral and catheter [[blood cultures]] simultaneously
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| **4x higher colony count in catheter blood cx suggests catheter is source of bacteremia
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| ***Even so catheter is only removed if fever persists for 2-3d after abx are started
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| ===Hemorrhage=== | | ===[[Altered Mental Status]]=== |
| *Potentially life-threatening | | *[[Hypotension]] |
| *Can result from aneurysms, anastomosis rupture, or over-anticoagulation | | *[[Hypoglycemia]] |
| *Control bleeding w/ pressure applied to puncture site for 5-10min; observee for 1-2hr | | *[[Hypercalcemia]] / [[Hyperkalemia]] / [[Hyponatremia]] |
| *Types
| | *[[Subdural hematoma]] |
| **Aneursym (true)
| | *[[Dysequilibrium syndrome]] - diagnosis of exclusion made after admission |
| ***Most are asymptomatic; rarely rupture
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| **Pseudoaneurysm
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| ***Results from subcutaneous extravasation of blood from puncture sites
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| ***Bleeding from puncture site is usually controlled by digital pressure or subq suture
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| ***Consider vascular surgery consultation for continued bleeding or infection
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| ***Arterial Doppler US studies can identify the aneurysm or pseudoaneurysm
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| ===Vascular insufficiency===
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| *Distal extremity becomes ischemic due shunting of arterial blood to venous side | |
| **Exercise pain, nonhealing ulcers, cool, pulseless digits | |
| **Diagnosed by Doppler US or angiography, repaired surgically
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| ===High-output heart failure===
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| *Occurs when >20% of cardiac output is diverted through the access
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| **Branham sign (drop in HR after temporary access occlusion) is diagnostic
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| **Doppler US can accurately measure access flow rate and establish the diagnosis
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| **Tx = surgical banding of the access
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| ==Peritoneal Dialysis Complications== | | ==References== |
| ===Peritonitis===
| | <references/> |
| ====Background====
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| *Most common complication
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| *Presentation no different from other causes of peritonitis
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| ====Diagnosis====
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| *Send dialysate fluid for cell count, Gram stain, cx (if available)
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| **Cell count >100 w/ >50% neutrophils most c/w infection
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| ====Treatment====
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| *Can add [[antibiotic] to the dialysate if possible (parenteral abx not required)
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| **1st gen [[cephalosporin]] or [[vancomycin]] (if pen allergic)
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| ==Source==
| | [[Category:Renal]] |
| Tintinalli
| | [[Category:Vascular]] |
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| [[Category:Nephro]] | |
