Diagnosis and Managment of Uremic Encephalopathy

Diagnosis and Managment of Uremic Encephalopathy

1. Dr. ahmad zahedi Uremic Encephalopathy

2. CONTAIN: Definition Physiology Pathophysiology Clinical manifestation Complication Investigation DDx Treatment

3. Definition Uremic encephalopathy : is an organic brain disorder and develops in patient with acute or chronic renal failure(e GFR<15ml/m) Uremia : group of symptoms that occur as a result of poor kidney function Azotemia: is a medical condition characterized by abnormally high levels of nitrogen-containing compounds

4. physiology Amino acid catabolism Ammoniac ( increase intracellular PH ) Liver ( co2 ) Solution in circulatory system Excretion : kidney , skin

5. pathophysiology Retention of uremic solutes Hormonal metabolism Electrolytes and acid-base homeostasis Increased vascular reactivity, BBB transport, and inflammation Imbalances of neurotransmitter within the brain Increase of glycine (N/vomiting, seizure, hypotension, oliguria, anuria, death) decrease of glutamine and GABA in CSF dysfunction in metabolism of dopamine and serotonin in brain(sensorial clouding) In progresses guanidine o compounds accumulation: NMDA activation and GABA inhibition(myoclonus, seizures). PTH

6. Causes of increases urea: 1 . More protein intake 2. Gastrointestinal bleeding 3 . dehydration

7. 4 . Drugs A llopurinol Aminoglycoside antibiotic Amphotericin B Aspirin ( high doses ) Carbamazepine Furosemide Spironolactone Methotrexate Methyl dopa

8. 5 . Renal failure Acute kidney injury pre renal Renal Post renal Chronic kidney disease

9. Sign and symptoms Early symptoms : Anorexia Nausea Restlessness Drowsiness Decreased concentration Slowed cognitive function

10. Late symptoms : Vomiting Decreased cognitive function Disorientation Confusion Bizarre behavior seizure Stupor , coma

11. Physical examination Nystagmus Papilledema Hyperrefelexia Myoclonus Asterixis Altered gait Stupor Coma

12. Differential diagnosis Hepatic encephalopathy Hyperparathyroidism Hypertensive encephalopathy Hypoglycemia Drug poisoning CVA Hyperosmolar coma Electrolyte imbalance

13. Complication: subdural hematoma Pericarditis Pulmonary edema

14. Laboratory finding Urea ( 160 mg ) BUN CBC Creatinine Glycaemia PTH Electrolyte Multi drug test LFT

15. I maging CT SCAN finding: Bilateral hypodensities : Basal ganglia Midbrain thalamus

16. MRI findings Increased signal intensity in cerebral cortex of basal ganglia ( lentiform fork sign )

17. Treatment: Dialysis Correction of anemia Regulation of calcium and phosphate metabolism Diet: avoid malnutrition and protein intake of 1.2gr/kg/day

18. Dialysis: Hemodialysis Peritoneal dialysis

19. Hemodialysis Arteriovenous fistula Prosthetic graft Infection Thrombosis Aneurysm 3-5 hour , 3 times a week

20. Peritoneal dialysis Peritonitis Nausea Vomiting Abdominal pain Diarrhea Constipation

21. Thanks for attention