Presentation
PowerPoint Presentation Last modified by: | PowerPoint PPT presentation | free to download Chronic Renal Failure, Proteinuria, Hematuria Jeffrey T. [powershow.com]
We present the case of a young adult with severe uremia who, despite application of recommended measures, developed DDS and non-cardiogenic pulmonary edema. [ncbi.nlm.nih.gov]
Case Presentation: A 70yo female with bipolar disorder and type 2 DM on metformin presented to the hospital with altered mental status, nausea/vomiting and diarrhea for 3 days. [shmabstracts.com]
Patients present with symptoms including headache, nausea, vomiting, muscle cramps, tremor, confusion, and convulsions. [visualdx.com]
Entire Body System
- Anemia
A normocytic normochromic anemia is present as early as stage 3 CKD and is almost universal by stage 4. 1 An anemia of chronic disease picture may also be seen. [emdocs.net]
Anemia. Not having enough red blood cells in your blood (anemia) is a common complication of kidney failure and hemodialysis. [mayoclinic.org]
| PowerPoint PPT presentation | free to view Quality of Life in Chronic Kidney Disease: CKD, ESRD, Anemia and Erythropoietin Paul L. [powershow.com]
Dry ice used to keep food cold, pyrethroid Pesticides Pre-existing illness—such as anemia, asthma, COPD, and coronary arterial disease—the stresses of flight could exacerbate symptoms. Nocebo effects can lead to health problems too. [wikivisually.com]
- Weakness
[…] mouth and gums or skin bruising - Frequent vomiting with or without blood - Black stools, like coal tar - Excessive thirst (dry mouth) - Pale, cold skin - Restlessness, or sleepiness Dengue shock syndrome is defined as dengue hemorrhagic fever plus: - Weak [denguevirusnet.com]
Due to the weakness they may present, it is good for the patient to avoid any physical effort. Additionally, it is always a good thing to have close friends or family to be there every time the patient needs it. [joecosgrovepentechealth.wordpress.com]
Hypocalcemia or hypermagnesemia may cause weakness and life-threatening dysrhythmias. Neuromuscular irritability is seen with hypocalcemia and may present as tetany or paresthesia. [emedicine.medscape.com]
Case Presentation A 47-year-old male developed an acute onset of weakness in the left extremities and slurred speech, following by unconsciousness. [smjournals.com]
The literature supporting the use of chlorhexidine to alter the oral microbiota to prevent caries is considered weak.16 Current recommendations for individuals at “high or extreme risk” for caries suggest that patients rinse with 0.12% chlorhexidine once [decisionsindentistry.com]
- Fatigue
DDS with milder symptoms including nausea, vomiting, headaches, fatigue, and restlessness can still be evident. [cureus.com]
Additional indications for dialysis include symptomatic uremia (Chap. 139) (e.g., intractable fatigue, anorexia, dysgeusia, nausea, vomiting, pruritus, difficulty maintaining attention and concentration) and protein-energy malnutrition/failure to thrive [accessmedicine.mhmedical.com]
Changes in sensorium include loss of memory, impaired concentration, depression, delusions, lethargy, irritability, fatigue, insomnia, psychosis, stupor, catatonia, and coma. [emedicine.medscape.com]
[…] start hemodialysis based on several factors, including your: Overall health Kidney function Signs and symptoms Quality of life Personal preferences You might notice signs and symptoms of kidney failure (uremia), such as nausea, vomiting, swelling or fatigue [mayoclinic.org]
One patient with SS may experience only mild symptoms, while another may present with sicca symptoms, as well as significant joint pain and fatigue. [decisionsindentistry.com]
- Malaise
Symptoms Onset within 12 hours of ral Malaise or Muscle cramping Cardiovascular Neurologic Motor Restlessness Confusion s V. Differential Diagnosis Malignancy Ventricular arrhythmia Intracerebral abscess (or ) VI. [tripdatabase.com]
Case presentation A 22-year-old homosexual male presented to hospital with progressive dyspnea, productive cough, generalized malaise and fever. [doi.org]
[…] after prolonged exposure to the offending drug which can be as long as six months or more or as short as 48 hours. [25],[26] This reaction, termed dapsone syndrome, is characterized by sudden onset of papular or exfoliative rash, accompanied by fever, malaise [ijdvl.com]
The findings may also be more subtle, with only malaise and a history of fever being described. These infections often require removal of the tunneled catheter if the patient appears ill or septic. [ahcmedia.com]
- Congestive Heart Failure
heart failure due to its antidiuretic effect Special considerations: if no IV access DDAVP can be administered intranasally at a dose of 3 mcg/kg, however IV dose is preferred. [emdocs.net]
Cardiac Hypertension Hyperlipidemia Congestive heart failure Uremic pericarditis Hematologic Gastrointestinal ... Nursing Care During Peritoneal ... disorder ... | PowerPoint PPT presentation | free to download ... [powershow.com]
Contributing factors include excessive salt and fluid intake; missed dialysis sessions; failure to achieve dry weight during dialysis; uncontrolled hypertension; pre-existing congestive heart failure; and new-onset acute coronary syndrome (ACS) or cardiac [ahcmedia.com]
Congestive heart failure in dialysis patients / Parfrey P.S., Harnett J.D., Griffiths S.M. et al. //Arch. Intern. Med. 1998. - N 148. - P. 1519-1525. 118. [medical-diss.com]
Respiratoric
- Dyspnea
She appeared to be in mild respiratory distress but denied dyspnea and was noted to have dry mucous membranes with a slightly distended abdomen. [shmabstracts.com]
Case presentation A 22-year-old homosexual male presented to hospital with progressive dyspnea, productive cough, generalized malaise and fever. [doi.org]
Patients with fluid overload present with the complaints of shortness of breath, dyspnea on exertion, fatigue, and increasing edema. [ahcmedia.com]
Gastrointestinal
- Nausea
This results in brain edema that manifests as neurological symptoms such as headache, nausea, vomiting, muscle cramps, tremors, disturbed consciousness, and convulsions. In severe cases, patients can die from advanced cerebral edema. [ncbi.nlm.nih.gov]
Clinical finding Headaches (often bilateral with throbbing), nausea, muscle cramps, hypertension, irritability, agitation, drowsiness, convulsions. [medical-dictionary.thefreedictionary.com]
After renal transplantation, the patient had complete resolution of headaches, nausea and the papilledema. [doi.org]
- Vomiting
This results in brain edema that manifests as neurological symptoms such as headache, nausea, vomiting, muscle cramps, tremors, disturbed consciousness, and convulsions. In severe cases, patients can die from advanced cerebral edema. [ncbi.nlm.nih.gov]
[…] di·al·y·sis dis·e·qui·lib·ri·um syn·drome nausea, vomiting, and hypertension, occasionally with convulsions, developing within several hours after starting hemodialysis for renal failure; apparently caused by too rapid removal of urea from the extracellular [medical-dictionary.thefreedictionary.com]
Mild forms of DDS present with nausea, vomiting, restlessness, and headache. Severe manifestations include seizures, obtundation, coma and even death. [shmabstracts.com]
Cardiovascular
- Hypertension
Intracranial hypertension was noted at 11:40 a.m., one hour after the start of hemodialysis (HD). [ccforum.biomedcentral.com]
Abstract In five patients with chronic renal failure, rapid correction by dialysis of hypertension and/or high blood urea levels provoked acute neurological disorders, followed by slowly reversible neuropsychiatric disturbances. [ncbi.nlm.nih.gov]
Clinical finding Headaches (often bilateral with throbbing), nausea, muscle cramps, hypertension, irritability, agitation, drowsiness, convulsions. [medical-dictionary.thefreedictionary.com]
Better manage your patients with up-to-date coverage on the latest advances in 13 new chapters including Hypertensive Kidney Disease, Vitamin D Deficiency, Diabetes Management, and more. [books.google.com]
Diagnosis Dialysis disequilibrium syndrome usually occurs during the patient’s first few dialysis sessions.3 The symptoms of the syndrome include:3 irritability restlessness headache nausea emesis hypertension blurred vision seizures muscular twitching [epilepsy.com]
- Hypotension
Following haemodialysis, he became hypotensive which required inotropes. His Riker's score was low with absence of brainstem reflexes after withholding sedation. [ncbi.nlm.nih.gov]
Dialysis Emergencies Part 1 (Hypotension, Bleeding, & Dialysis Disequilibrium … Mel Herbert, MD MBBS FAAEM and Stuart Swadron, MD, FRCPC [emrap.org]
MSN, CCRN ; Kearney, Kathleen MSN, CEN Emergency Abstract Author Information Authors When a change in mental status is accompanied by hypotension, it may not be due to uremia. Carl A. [journals.lww.com]
- Heart Failure
The primary cause of death is renal failure and disseminated WT but respiratory and heart failure have also been reported. [orpha.net]
Our 82-year old female patient, on haemodialysis throughout the past six months due to chronic renal failure (CRF) secondary to amyloidosis, was admitted for heart failure. [revistanefrologia.com]
failure due to its antidiuretic effect Special considerations: if no IV access DDAVP can be administered intranasally at a dose of 3 mcg/kg, however IV dose is preferred. [emdocs.net]
Cardiac Hypertension Hyperlipidemia Congestive heart failure Uremic pericarditis Hematologic Gastrointestinal ... Nursing Care During Peritoneal ... disorder ... | PowerPoint PPT presentation | free to download ... [powershow.com]
Contributing factors include excessive salt and fluid intake; missed dialysis sessions; failure to achieve dry weight during dialysis; uncontrolled hypertension; pre-existing congestive heart failure; and new-onset acute coronary syndrome (ACS) or cardiac [ahcmedia.com]
Skin
- Flushing
The illness often begins with a sudden rise in temperature accompanied by facial flush and other flu-like symptoms. The fever usually continues for two to seven days and can be as high as 41°C, possibly with convulsions and other complications. [denguevirusnet.com]
Otherwise, flush the dose with 10 mL of saline. The onset of effects is about 20 minutes, and lasts for 4-6 hours. [ahcmedia.com]
- Pruritus
Additional indications for dialysis include symptomatic uremia (Chap. 139) (e.g., intractable fatigue, anorexia, dysgeusia, nausea, vomiting, pruritus, difficulty maintaining attention and concentration) and protein-energy malnutrition/failure to thrive [accessmedicine.mhmedical.com]
Prevalence and characterization of uremic pruritus in patients undergoing hemodialysis: uremic pruritus is still a major problem for patients with end-stage renal disease. J Am Acad Dermatol. 2003 Nov. 49(5):842-6. [Medline]. [emedicine.medscape.com]
- Sweating
Disequilibrium syndrome of dialysis has essentially the same symptoms as cerebral edema: dizzy, faint, lightheaded, ringing in the ears, racing pulse, feeling warm, sweating, nausea, vomiting, yawning, itching and severe muscle cramps (anywhere on the [allnurses.com]
SAPHO 증후군(SAPHO syndrome) 색소성 융모결절성 활막염(Pigmented villonodular synovitis) 소아 양성 돌발성 현훈(Benign paroxysmal vertigo of childhood) 쇼그렌 증후군 섬유근육통 심장 X 증후군(Cardiac syndrome X) 알츠하이머병 양성 근육다발수축 증후군(Benign fasciculation syndrome) 열대성 스프루 영아돌연사증후군 영국 다한증(English sweating [ko.wikipedia.org]
Eyes
- Blurred Vision
After one particularly severe episode, which was associated with vomiting, restlessness and blurred vision, her team suspected that she was developing dialysis disequilibrium syndrome. [casereports.bmj.com]
Symptoms Symptoms result from brain edema, varying from mild to severe: Headache Nausea with or without vomiting Dizziness Muscle cramp Blurred vision Tremors Restlessness Agitation Alteration of consciousness Seizure Coma Sudden cardiac arrest Syndrome [renalandurologynews.com]
Diagnosis Dialysis disequilibrium syndrome usually occurs during the patient’s first few dialysis sessions.3 The symptoms of the syndrome include:3 irritability restlessness headache nausea emesis hypertension blurred vision seizures muscular twitching [epilepsy.com]
Patients will probably also have a bit of irritability, nausea, vomiting, blurred vision and delirium that can even last for a few days. [joecosgrovepentechealth.wordpress.com]
Musculoskeletal
- Muscle Cramp
This results in brain edema that manifests as neurological symptoms such as headache, nausea, vomiting, muscle cramps, tremors, disturbed consciousness, and convulsions. In severe cases, patients can die from advanced cerebral edema. [ncbi.nlm.nih.gov]
Patients present with symptoms including headache, nausea, vomiting, muscle cramps, tremor, confusion, and convulsions. [visualdx.com]
Manifestations range from headache, muscle cramps, and nausea, to seizures, altered sensorium and rarely coma or death. [n.neurology.org]
Clinical finding Headaches (often bilateral with throbbing), nausea, muscle cramps, hypertension, irritability, agitation, drowsiness, convulsions. [medical-dictionary.thefreedictionary.com]
Urogenital
- Uremia
TY - JOUR T1 - Dialysis disequilibrium syndrome and other treatment complications of extreme uremia: a rare occurrence yet not vanished. [unboundmedicine.com]
The effects of dialysis on brain water and EEG in stable chronic uremia. Am J Kidney Dis. 1987 Jun; 9 (6):462–469. [ PubMed ] [ Google Scholar ] Arieff AI, Guisado R, Massry SG, Lazarowitz VC. [pubmedcentral.nih.gov]
We present the case of a young adult with severe uremia who, despite application of recommended measures, developed DDS and non-cardiogenic pulmonary edema. [ncbi.nlm.nih.gov]
CNS, HD 4 2017 Asymptomatic Brain Edema after Hemodialysis Initiation in a Patient with Severe Uremia. MRI 5 2017 Cerebral Edema in a Child after Preemptive Kidney Transplantation. [allie.dbcls.jp]
We present the case of a young adult with severe uremia who, despite application of recommended measures, developed DDS and non‐cardiogenic pulmonary edema. [onlinelibrary.wiley.com]
- Polyuria
A fatal case of cerebral oedema with hyponatraemia and massive polyuria after renal transplantation. Pediatr Nephrol 2009; 24 (6) 1231-1234 11 Armour A. [thieme-connect.com]
Neurologic
- Headache
This results in brain edema that manifests as neurological symptoms such as headache, nausea, vomiting, muscle cramps, tremors, disturbed consciousness, and convulsions. In severe cases, patients can die from advanced cerebral edema. [ncbi.nlm.nih.gov]
After renal transplantation, the patient had complete resolution of headaches, nausea and the papilledema. [doi.org]
- Seizure
Other disorders that can cause seizures in renal insufficiency need to be excluded. [epilepsy.com]
If seizures ever happen, the typical recommendation is to stop dialysis and initiate antiseizure medications. The intensity and the aggressiveness of dialysis might need to be reduced for future treatments. Thanks for your feedback! [verywellhealth.com]
Immediately on completion of HD, the patient had a witnessed tonic-clonic seizure which lasted 30 s and self-terminated. She subsequently had a respiratory arrest secondary to this seizure with a corresponding GCS of 3. [journals.sagepub.com]
Manifestations range from headache, muscle cramps, and nausea, to seizures, altered sensorium and rarely coma or death. [n.neurology.org]
More severe manifestations which are rare include seizures, altered mental status, coma, and death [3]. Seizures are usually transient. Death may occur from central herniation. [cureus.com]
- Confusion
Patients present with symptoms including headache, nausea, vomiting, muscle cramps, tremor, confusion, and convulsions. [visualdx.com]
Risk Factors: First time dialysis session High BUN Children Elderly Preexisting cerebral edema Symtoms: Nausea/Vomiting Headache Confusion Dizziness Seizures Coma Death Differential Diagnosis: Hypovolemia Electrolyte abnormalities Hemolysis Infection [emdaily.cooperhealth.org]
Clinical features of DDS: (1) headache (2) nausea and/or vomiting (3) disorientation (4) visual disturbances, often with papilledema (5) asterixis (6) variable confusion (7) variable lethargy (8) variable seizures (9) variable coma (10) elevated intracranial [meducator3.net]
Occasionally, confusion or other central nervous system symptoms will occur. The dialysis “disequilibrium syndrome” refers to the development of headache, confusion, and rarely seizures, in association ... [accessmedicine.mhmedical.com]
Here is a non-inclusive list of symptoms: Nausea Headache Disorientation Confusion Cramps Dizziness Seizures Coma, or death in severe cases Causes You would think that with dialysis being around for half a century, we would understand all its adverse [verywellhealth.com]
- Tremor
This results in brain edema that manifests as neurological symptoms such as headache, nausea, vomiting, muscle cramps, tremors, disturbed consciousness, and convulsions. In severe cases, patients can die from advanced cerebral edema. [ncbi.nlm.nih.gov]
Patients present with symptoms including headache, nausea, vomiting, muscle cramps, tremor, confusion, and convulsions. [visualdx.com]
Symptoms Symptoms result from brain edema, varying from mild to severe: Headache Nausea with or without vomiting Dizziness Muscle cramp Blurred vision Tremors Restlessness Agitation Alteration of consciousness Seizure Coma Sudden cardiac arrest Syndrome [renalandurologynews.com]
- Lethargy
Clinical features of DDS: (1) headache (2) nausea and/or vomiting (3) disorientation (4) visual disturbances, often with papilledema (5) asterixis (6) variable confusion (7) variable lethargy (8) variable seizures (9) variable coma (10) elevated intracranial [meducator3.net]
Case reports Patient 1 A 14-year-old male with known developmental delay presented with 7 days of emesis, decreased fluid intake and lethargy. He had weight loss and had suffered from anorexia for ∼1 year. [academic.oup.com]
Signs of Wilms tumor can include abdominal swelling, blood in the urine, decreased urination, low-grade fever, loss of appetite, paleness, weight loss and lethargy. [rarediseases.org]
She now presented in the emergency room with uremic symptoms (tiredness, lethargy, loss of appetite, nausea and vomiting). She gave no history of headache, loss of consciousness, confusion, seizures or signs of fluid overload. [sjkdt.org]
Workup
Hypocalcemia Intracranial Bleed Hypertensive Emergency Stroke Supratheurapeutic Medication Effects PRES Dialysis Complications Dialysis-associated hypotension Dialysis disequilibrium syndrome Air embolism Missed dialysis (pulmonary edema) Evaluation Workup [wikem.org]
Further workup did not reveal any clear toxic, cerebrovascular or metabolic cause. I’m not sure what role dialysis played in the seizure but we did do our best to try and minimize the risk of DDS. [renalfellow.blogspot.com]
Following septic workup, his antibiotic management was changed to meropenem. [onlinejets.org]
Serum
- Hypoglycemia
No gold standard for definitive diagnosis, thus mostly diagnosed by exclusion Laboratory tests and imaging studies should be ordered to identify other potential causes: Blood glucose (to exclude hypoglycemia) Serum calcium (to exclude hypocalcemia or [renalandurologynews.com]
Asterixis Muscle Cramps Can progress to seizure, coma, and death[3] Differential Diagnosis Subdural hematoma Uremia Nonketotic hyperosmolar coma Acute cerebrovascular event Dialysis dementia Excessive ultrafiltration and seizure Metabolic disturbances Hypoglycemia [wikem.org]
Nevertheless, there are many of other disorders that needs to be excluded including uremia itself, subdural hematoma, metabolic disturbances (hyponatremia, hypoglycemia), and drug-induced encephalopathy. [dealingwithtinnitus.com]
Clinically, the diagnosis of DDS is one of exclusion and should be distinguished from the similar symptoms and signs of intracranial hypertension resulting from subdural hematoma, uremia, nonketotic hyperosmolar coma, acute stroke, dialysis dementia, hypoglycemia [smjournals.com]
Treatment
Qb and treatment time can be increased in a step wise manner over the next 3-4 daily treatments. This is incorrect. Try again. [hemodialysiskinetics.coursepress.yale.edu]
Once established, treatment should be focused on supportive therapy. [unboundmedicine.com]
The blood purifying treatment for their chronic kidney disease is already pretty aggressive, and it gets even tougher when this treatment gets unexpected complications. [joecosgrovepentechealth.wordpress.com]
Although it has been reported in patients receiving chronic HD, DDS is more common during or immediately after the first HD treatment. The exact incidence of DDS is unknown. [ncbi.nlm.nih.gov]
This comprehensive text reference seeks to assist physicians with treatment by providing an easy-to-use compendium covering the treatment and management of all neurological diseases along with details on the natural course of these diseases. [books.google.com]
Prognosis
Prognosis The prognosis varies widely with most of the subjects living into adulthood. The primary cause of death is renal failure and disseminated WT but respiratory and heart failure have also been reported. [orpha.net]
The prognosis is poor when this manifests with serious neurological manifestations like seizures and obtundation. Evidence in effective management is sparse. [cureus.com]
These mutations are usually found in exons 8 or 9, but at least one has been reported in exon 4.[1] Prognosis[edit] A 1994 review of 150 cases reported in the literature found that 38% had died with a mean age of death of 2 years. 32% were still alive [en.wikipedia.org]
Detailed clinical manifestations at onset and prognosis of neonatal-onset Denys-Drash syndrome and congenital nephrotic syndrome of the Finnish type. Clin Exp Nephrol. 2019 Aug. 23 (8):1058-1065. [Medline]. [emedicine.medscape.com]
Hence, either elevated ICP and/or shock may lead to poor CPP and worsened prognosis. [jmedscindmc.com]
Etiology
Costen's syndrome has been debated as a single entity standing or falling by the correctness of every one of its symptoms, by the validity of the etiology given by Costen, and by the success of its treatment by "opening the bite." [jamanetwork.com]
Therefore, the literature has been surveyed with respect to terminology, etiology, systemic manifestations, including urethritis, arthritis, conjunctivitis, skin (especally penile) lesions, and oral manifestations, and the incidence of oral lesions, pathology [oooojournal.net]
특발성 두개골 내부 긴장 항진(Idiopathic intracranial hypertension) 폭발성 머리 증후군(Exploding head syndrome) 플로우팅-하버 증후군(Floating–Harbor syndrome) 피부근염 Danubian endemic familial nephropathy (DEFN) Fields' disease Synovial osteochondromatosis (SOC) Villitis of unknown etiology [ko.wikipedia.org]
Etiology The cause of DDS is currently not well understood. [ipfs.io]
Elderly and pediatric patients Patients with pre-existing CNS lesions (recent stroke, head trauma) or conditions characterized by cerebral edema (malignant hypertension, hyponatremia, hepatic encephalopathy) High pre-dialysis BUN Severe metabolic acidosis Etiology [advancedrenaleducation.com]
Epidemiology
In summary, the precise epidemiology and pathophysiology of DDS remain unclear. [doi.org]
Epidemiology Rare, but potentially lethal III. Pathophysiology: Dialysis complication Rapid decrease in during IV. Symptoms Onset within 12 hours of ral Malaise or Muscle cramping Cardiovascular Neurologic Motor Restlessness Confusion s V. [tripdatabase.com]
Summary Epidemiology The prevalence is not known. Fewer than 300 cases have been reported in the literature to date. [orpha.net]
Journal of chronic diseases, Vol. 28, No. 11-12, pp. 637-59 [ PM ] [ EČ ][ GS ] Valeri, A., Radhakrishnan, J., Vernocchi, L., Carmichael, L.D., Stern, L. (1993) The epidemiology of peritonitis in acute peritoneal dialysis: A comparison between open- and [scindeks.ceon.rs]
Pathophysiology
Recent advancements in cell biology implicate the role of urea disequilibrium (with a smaller contribution from organic osmolytes) as the pathophysiological mechanism responsible for this syndrome. [ncbi.nlm.nih.gov]
This also makes studying the pathophysiology in humans challenging. [dovepress.com]
Using a case study, this article discusses the pathophysiology, clinical manifestations, prevention, and management of dialysis disequilibrium syndrome. [augusta.pure.elsevier.com]
Prevention
Using a case study, this article discusses the pathophysiology, clinical manifestations, prevention, and management of dialysis disequilibrium syndrome. [ncbi.nlm.nih.gov]
While the focus of this review is the prevention and management of DDS, there will be an emphasis on what is known about the pathophysiology because it strongly impacts the prevention and management strategies. [dovepress.com]
Experimental dialysis disequilibrium syndrome: prevention with glycerol. Kidney Int. 1978 Sep; 14 (3):270–278. [ PubMed ] [ Google Scholar ] Port FK, Johnson WJ, Klass DW. [pubmedcentral.nih.gov]
Skip to main content Title Dialysis disequilibrium syndrome prevention and management. [hsrc.himmelfarb.gwu.edu]