Nephrology Hypertension

Hemodialysis: Acute Complications – Sudden Cardiac Arrest

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,…

Hemodialysis: Acute Complications – Muscle Cramping

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)…

Hemodialysis: Acute Complications – Dialysis-associated Vascular Steal Syndrome

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…

Hemodialysis: Acute Complications – Air Embolism

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,…

Hemodialysis: Acute Complications – Anaphylactic/Anaphylactoid Reactions

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…

Hemodialysis: Acute Complications – Intradialytic hypertension

Does this patient have intradialytic hypertension? Intradialytic hypertension is defined as an intradialytic increase in the systolic blood pressure by greater or equal than 10 mmHg or the mean arterial pressure by greater or equal than 15 mmHg. The hypertension usually develops during the second or third hour of hemodialysis after significant ultrafiltration has taken…

Hemodialysis: Acute Complications – Intradialytic hypotension

Does this patient have intradialytic hypotension? Intradialytic hypotension is defined as a systolic blood pressure of less than 100 mmHg or a systolic blood pressure decrease of greater than 10 mmHg, or a mean arterial pressure decrease of greater than 30 mmHg with or without symptoms. Symptoms result from decreased tissue perfusion, and vary in…

Pre-eclampsia

Does this patient have pre-eclampsia? How do you diagnose pre-eclampsia? Preeclampsia is defined as the new onset of hypertension (BP > 140/90) and proteinuria (≥ 300 mg protein in a 24-hr urine collection) after 20 weeks of gestational. Hypertension plus other signs such as thrombocytopenia, elevated serum transaminase levels, or systemic organ failure is also…

Hypertension in Pregnancy

Does this pregnant patient have hypertension? How do you diagnose and treat hypertension in a pregnant patient? Hypertension complicates 5-15% of pregnancies. Hypertensive disorders of pregnancy are classified as the following: Preexisting hypertension: Systolic pressure >= 140 mmHg and / or diastolic pressure >= 90 prior to pregnancy, present before the 20th week of pregnancy,…

Diseases of Volume Regulation: Volume Overload

Does this patient have volume overload? Like volume depletion, the diagnosis of volume overload is made predominantly on clinical grounds. Laboratory tests are only supportive. Volume overload can result from primary renal salt retention, or the renal salt retention can be secondary to other processes. When the salt retention is primary, then the predominant manifestation…

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