DIALYSIS DISEQUILIBRIUM SYNDROME: A RARE CAUSE OF DELIRIUM IN THE ICU

Normal neurologic function requires a constantly balanced environment of electrolytes. Normal hepatic and renal function is critical in maintaining this balance while removing toxins, maintaining a physiologic pH and regulating the excretion of electrolytes. Nutritional intake provides essential nutrients but deficiencies can lead to characteristic syndromes such as Wernicke's encephalopathy and pellagra and exposure to neurotoxic substances such as heavy metals can lead to encephalopathy. Thyroid and adrenal dysfunction are common endocrine causes of encephalopathy and symptoms can often improve rapidly with treatment. A subset of idiopathic encephalopathy is increasingly being recognized as having an autoimmune basis, often presenting as a paraneoplastic process, and having a constellation of symptoms which can aide in the diagnosis. Timely recognition and treatment of the autoantibodies which target neural structures, with immunosuppressive therapy, can improve outcome in these patients. This review contains 4 figures, 3 tables, and 42 references. Key words: osmotic demyelination syndrome,hepatic encephalopathy, renal failure, triphasic waves, dialysis disequilibrium syndrome, Wernicke encephalopathy, Korsakoff syndrome, myxedema coma, Hashimoto encephalopathy

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Metabolic Encephalopathy - Part II

10.2310/vasc.1393 ◽

2019 ◽

Author(s):

Rick Gill ◽

Matthew McCoyd ◽

Sean Ruland ◽

José Biller

Keyword(s):

Nutritional Intake ◽

Osmotic Demyelination Syndrome ◽

Wernicke Encephalopathy ◽

Metabolic Encephalopathy ◽

Improve Outcome ◽

Myxedema Coma ◽

Hashimoto Encephalopathy ◽

Korsakoff Syndrome ◽

Dialysis Disequilibrium Syndrome ◽

Neurologic Function

Normal neurologic function requires a constantly balanced environment of electrolytes. Normal hepatic and renal function is critical in maintaining this balance while removing toxins, maintaining a physiologic pH and regulating the excretion of electrolytes. Nutritional intake provides essential nutrients but deficiencies can lead to characteristic syndromes such as Wernicke's encephalopathy and pellagra and exposure to neurotoxic substances such as heavy metals can lead to encephalopathy. Thyroid and adrenal dysfunction are common endocrine causes of encephalopathy and symptoms can often improve rapidly with treatment. A subset of idiopathic encephalopathy is increasingly being recognized as having an autoimmune basis, often presenting as a paraneoplastic process, and having a constellation of symptoms which can aide in the diagnosis. Timely recognition and treatment of the autoantibodies which target neural structures, with immunosuppressive therapy, can improve outcome in these patients. This review contains 4 figures, 3 tables, and 42 references. Key words: osmotic demyelination syndrome,hepatic encephalopathy, renal failure, triphasic waves, dialysis disequilibrium syndrome, Wernicke encephalopathy, Korsakoff syndrome, myxedema coma, Hashimoto encephalopathy

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Hubungan Tingkat Kecemasan Dengan Hemodinamik Pasien Gagal Ginjal Kronik Yang Menjalani Hemodialisa

Jurnal Karya Abdi Masyarakat ◽

10.22437/jkam.v3i2.8464 ◽

2019 ◽

Vol 3 (2) ◽

pp. 100-111

Author(s):

Nurlinawati Nurlinawati ◽

Dini Rudini ◽

Yuliana Yuliana

Keyword(s):

Mean Arterial Pressure ◽

Arterial Pressure ◽

Cross Sectional ◽

Dialysis Disequilibrium Syndrome

Latar Belakang : Pasien hemodialisis seringkali mengalami kecemasan. Kecemasan ini apabila tidak diatasi akan mempengaruhi aspek fisiologis dan hemodinamik yang dikhawatirkan akan menimbulkan komplikasi yaitu dialysis disequilibrium syndrome. Penelitian ini bertujuan untuk mengetahui hubungan tingkat kecemasan dengan kondisi hemodinamik pasien gagal ginjal kronik yang sedang menjalani hemodialisa. Metode : Jenis penelitian kuantitatif dengan menggunakan cross sectional. Sampel dalam penelitian ini berjumlah 57 responden. Analisis univariat menggunakan distribusi frekuensi dan analisis bivariat menggunakan regresi linier sederhana. Hasil : Hasil penelitian didapat tingkat kecemasan hanya berhubungan dengan Mean Arterial Pressure (MAP) sebelum hemodialisis dengan nilai signifikan 0.023 dan sesudah hemodialisis didapatkan nilai signifikan 0.026. Sedangkan nadi dan respirasi rate tidak terdapat hubungan dengan nilai signifikan >0.05. Kesimpulan : Ada hubungan antara tingkat kecemasan dengan Mean Arterial Pressure (MAP) pasien gagal ginjal kronik yang sedang menjalani hemodialisa di ruang Hemodialisa RSUD Raden Mattaher Jambi Tahun 2018.

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Continuous venovenous hemodialysis

American Journal of Critical Care ◽

10.4037/ajcc1994.3.2.92 ◽

1994 ◽

Vol 3 (2) ◽

pp. 92-99 ◽

Cited By ~ 3

Author(s):

BL Strohschein ◽

DM Caruso ◽

KA Greene

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Hemodynamic Instability ◽

Cerebellar Hemorrhage ◽

Renal Replacement Therapies ◽

Surgical Evacuation ◽

Fluid Shifts ◽

Continuous Venovenous Hemodialysis ◽

Dialysis Disequilibrium Syndrome ◽

Continuous Hemodialysis

Hemodialysis and peritoneal dialysis are the main renal replacement therapies for patients with acute renal failure. These patients are often unable to tolerate drastic fluid shifts and other complications of conventional dialysis. Continuous hemodialysis, however, provides protection from the hemodynamic consequences and osmotic stressors of conventional dialysis and is rapidly becoming the treatment of choice for critically ill patients. We present a case in which a patient with a spontaneous cerebellar hemorrhage developed acute renal failure. Surgical evacuation was not an option. Clinical management included the use of continuous venovenous hemodialysis, which is described in the setting of a patient with a posterior fossa mass. The risks of anticoagulation, hemodynamic instability, and development of dialysis disequilibrium syndrome are discussed.

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