Bertrand L. Jaber

Does this patient have intrdialytic hemolysis? Grossly translucent hemolyzed blood in the extracorporeal blood line Symptoms vary depending on causes and severity Continue Reading Causes Mechanical 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),…

Does this patient have seizure? Focal or generalized seizure Causes Hyponatremia Hypoglycemia Continue Reading Hypercalcemia 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)…

Does this patient have dialysis-induced headache? Symptoms Bifrontal discomfort (throbbing) Nausea with or without vomiting Aggravated by supine position No accompanying visual disturbances Continue Reading 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…

Does this patient have dialysis disequilibrium syndrome? Symptoms Symptoms result from brain edema, varying from mild to severe: Headache Nausea with or without vomitingContinue Reading Dizziness 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 sudden cardiac arrest? Symptoms Loss of consciousness Signs Loss of pulse Continue Reading Differential diagnosis Cardiac cause: acute myocardial infarction, cardiac arrhythmias, cardiac tamponade, hypotension from excessive ultrafiltration Electrolyte disturbances: hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia, hypermagnesemia Technical problems: massive air embolism, acute hemolysis, massive blood loss, anaphylactic/anaphylactoid reaction related to dialyzer,…

Does this patient have muscle cramping? Symptoms Muscle cramping Restlessness Continue Reading Agitation 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)…

Does this patient have dialysis-associated vascular steal syndrome? Symptoms (the classic 6 Ps) Pain Paresthesia Paralysis Pulselessness Continue Reading Poikilothermia 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…

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 Continue Reading Supine position Impaired right ventricular function (decreased cardiac output and hypotension) Microemboli to pulmonary vasculature (dyspnea, dry cough, chest tightness or pain,…

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