Difference between revisions of "Dialysis complications"

(Created page with "==Hypotension== ===Background=== #Most frequent complication of hemodialysis, occurring during 20% to 30% of treatments #Timing of intradialytic hypotension is helpful in formula...")
 
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==Hypotension==
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{{Dialysis complications DDX}}
===Background===
 
#Most frequent complication of hemodialysis, occurring during 20% to 30% of treatments
 
#Timing of intradialytic hypotension is helpful in formulating DDX:
 
##Hypotension early in session usually due to preexisting hypovolemia
 
##Hypotension during the session is often due to blood loss (from tubing or filter leak)
 
##Hypotension near the end usually result of excessive ultrafiltration
 
###Underestimation of pt's ideal blood volume (dry weight)
 
###Also consider pericardial or cardiac disease
 
  
===Clinical Features===
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{{AV shunt complications DDX}}
#N/V
 
#Anxiety
 
#Dizziness
 
#Orthostatic hypotension
 
#Syncope
 
  
===Diagnosis===
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===Peritoneal Dialysis Complications===
#Assess:
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*[[Peritoneal dialysis-associated peritonitis]]
##Volume status (US)
 
##Cardiac function
 
##Pericardial disease
 
##Infection
 
##GI bleeding
 
  
===DDX===
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===Cardiovascular===
#Excessive ultrafiltration
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*[[Cardiac tamponade]]
#Predialytic volume loss
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*[[Pericarditis]]
##GI losses
 
##Decreased oral intake
 
#Intradialytic volume loss
 
##Tube and hemodialyzer blood losses
 
#Postdialytic volume loss
 
##Vascular access blood loss
 
#Medication effects
 
##Antihypertensives
 
##Opiates
 
#Decreased vascular tone (sepsis)
 
#Cardiac dysfunction
 
##LVH, ischemia, hypoxia, arrhythmia, pericardial tamponade
 
#Pericardial disease
 
##Effusion
 
##Tamponade
 
  
==Dialysis Disequilibrium Syndrome==
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{{ESRD Associated Skin Conditions}}
###Clinical syndrome occurring at end of dialysis
 
###Characterized by N/V, HTN (can progress to seizure, coma, death)
 
###Large solute clearances -> cerebral edema
 
####Occurs most commonly during initial dialysis or during hypercatabolic states
 
###Treatment
 
####Mannitol
 
  
==Air Embolism==
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===Altered Mental Status===
###Acute dyspnea, chest tightness, LOC, cardiac arrest
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*Hypotension
###Treatment
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*[[Hypoglycemia]]
####100% NRB
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*[[Hypercalcemia]] / [[Hyperkalemia]] / [[Hyponatremia]]
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*[[Subdural hematoma]]
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*[[Dysequilibrium syndrome]] - diagnosis of exclusion made after admission
  
==Vascular Access Complications==
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==References==
===Thrombosis and Stenosis===
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<references/>
#Most common causes of inadequate dialysis flow
 
##Loss of bruit and thrill over access
 
#Stenosis and even thrombosis are not emergencies
 
##Can be treated w/in 24hr by angiographic clot removal or angioplasty
 
##Thrombosis of vascular access can be treated w/ direct injection of alteplase 2.2mg ###This therapy should be discussed with the vascular surgeon first
 
===Vascular Access Infection===
 
#Pts often p/w signs of systemic sepsis (fever, hypotension, leukocytosis)
 
##Classic signs of pain, erythema, swelling, d/c from infected access are often missing
 
#Dialysis catheter–related bacteremia is common and potentially life-threatening
 
##Give vancomycin 1gm IV +/- genamicin 100mg IV (if gram neg suspected)
 
##Do not remove dialysis patient's access
 
#Draw peripheral and catheter blood cultures simultaneously
 
##4x higher colony count in catheter blood cx suggests catheter is source of bacteremia
 
###Even so catheter is only removed if fever persists for 2-3d after abx are started
 
===Hemorrhage===
 
#Potentially life-threatening
 
#Can result from aneurysms, anastomosis rupture, or over-anticoagulation
 
#Control bleeding w/ pressure applied to puncture site for 5-10min; observee for 1-2hr
 
#Types
 
##Aneursym (true)
 
###Most are asymptomatic; rarely rupture
 
##Pseudoaneurysm
 
###Result from subcutaneous extravasation of blood from puncture sites
 
###Bleeding from puncture site is usually controlled by digital pressure or subq suture
 
###Consider vascular surgery consultation for continued bleeding or infection
 
###Arterial Doppler US studies can identify the aneurysm or pseudoaneurysm
 
===Vascular insufficiency===
 
#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
 
===High-output heart failure===
 
#Occurs when >20% of cardiac output is diverted through the access
 
##Branham sign (drop in HR after temporary access occlusion) is diagnostic
 
##Doppler US can accurately measure access flow rate and establish the diagnosis ##Surgical banding of the access is treatment of choice
 
  
==Source==
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[[Category:Renal]]
Tintinalli
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[[Category:Vascular]]
 
 
[[Category:Nephro]]
 

Latest revision as of 04:28, 31 July 2016