Hemodialysis: Chapter 8, Complications During Hemodialysis, Part 2 - Dr.Gawad

- Video recording of this lecture in English language: https://youtu.be/FHV_jNJUt3Y
- Video recording of this lecture in Arabic language: https://youtu.be/D5kYfTMFA8E
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1. Mohammed Abdel Gawad MD/PhD Neph, ESENeph
Nephrology Unit, School of Medicine, NewGiza University
Nephrology Consultant, Alexandria
Founder of NephroTube.com
Chair of AFRAN Web/Media Committee
ISN Education SoMe Team Member
Chapter 8
Complications During
Hemodialysis
Part 2
•Muscle cramps
•Hemolysis
•Air embolism
•Disequilibriumsyndrome
•Seizures
You can get this book free from www.NephroTube.com

2. Watch the video recording of this lecture
on NephroTube YouTube channel
www.YouTube.com/NephroTube

3. Visit
www.NephroTube.com
to get more Nephrology lectures
(pdf and video recordings)

4. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

5. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

6. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement
Muscle cramps are commonly observed near
the end of the dialysis session.

7. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

8. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Pathogenesis of muscle cramps during hemodialysis
session
- Hypotension /
hypovolemia
- Hypo-osmolarity
Electrolyte
disturbance
- Low-sodium dialysate
- Hypocalcemia
- Hypomagnesemia
- Pre-dialysis hypokalemia
Peripheral vascular
disease

9. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

10. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Management of muscle cramps
Intravenous
solutions
0.9% saline
- When hypotension
and muscle cramps
occur concomitantly,
- It does not always
resolve the cramp
Hypertonic
glucose
Physical
therapy
- Forced stretching
- Massage
- Local heat application
Nasal
administration
of oxygen
Nifedipine 10 mg
sometimes in
hemodynamically
stable patients

11. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Management of muscle cramps
Intravenous
solutions
0.9% saline
- When hypotension
and muscle cramps
occur concomitantly,
- It does not always
resolve the cramp
Hypertonic
glucose
Physical
therapy
- Forced stretching
- Massage
- Local heat application
Nasal
administration
of oxygen
Nifedipine 10 mg
sometimes in
hemodynamically
stable patients

12. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

13. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com

14. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com

15. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com

16. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

17. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Causes of hemolysis during hemodialysis session
Faulty roller
pump
Obstruction and/or
narrowing in bloodline,
needle, or catheter
Problems with
dialysis
solution
- Overheated dialysate.
- Hypotonic dialysate
- Dialysate is contaminated with chloramines,
chlorine, copper, or nitrates.

18. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Causes of hemolysis during hemodialysis session
Faulty roller
pump
Obstruction and/or
narrowing in bloodline,
needle, or catheter
Problems with
dialysis
solution
- Overheated dialysate.
- Hypotonic dialysate
- Dialysate is contaminated with chloramines,
chlorine, copper, or nitrates.

19. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

20. Manifestations of hemolysis
In cases of acute massive hemolysis:
•Back pain, chest tightness and shortness of breath
•Port-wine appearance of blood in the venous bloodline and a pink
discoloration of the plasma in centrifuged blood samples.
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com

21. Manifestations of hemolysis
In cases of acute massive hemolysis:
•Back pain, chest tightness and shortness of breath
•Port-wine appearance of blood in the venous bloodline and a pink
discoloration of the plasma in centrifuged blood samples.
•Severe decrease in hematocrit
•Hyperkalemia
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com

22. Manifestations of hemolysis
In cases of acute massive hemolysis:
•Back pain, chest tightness and shortness of breath
•Port-wine appearance of blood in the venous bloodline and a pink
discoloration of the plasma in centrifuged blood samples.
•Severe decrease in hematocrit
•Hyperkalemia
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Chronic mild subclinical hemolysis diagnosis is challenging,
and diagnostic investigations are usually needed

23. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

24. Management of hemolysis
•Stop dialysis and hospitalize the patient
•Order: Laboratory tests (K, CBC, reticulocyte count, LDH) and ECG
•Manage: Blood transfusion and hyperkalemia
•Search for the cause
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com

25. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

26. Sites of air entry during hemodialysis session
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com

27. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

28. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Manifestations of air embolism
Foam is observed in the
venous bloodline
position-dependent
Seated patients: Air travels to the
cerebral venous system and
obstructs it
Recumbent
patients
The air enters the heart (churning
sound) and obstructs the right
ventricular outflow
Further air
passage to
the lungs
obstructs
pulmonary
capillaries
Further passage of air across the pulmonary capillary bed
into the left ventricle can result in air embolization to the
arteries of:
- The brain, which causes acute neurologic.
- The heart, which causes cardiac dysfunction

29. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Manifestations of air embolism
Foam is observed in the
venous bloodline
position-dependent
Seated patients: Air travels to the
cerebral venous system and
obstructs it
Recumbent
patients
The air enters the heart (churning
sound) and obstructs the right
ventricular outflow
Further air
passage to
the lungs
obstructs
pulmonary
capillaries
Further passage of air across the pulmonary capillary bed
into the left ventricle can result in air embolization to the
arteries of:
- The brain, which causes acute neurologic.
- The heart, which causes cardiac dysfunction

30. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

31. Management of air embolism
•Stop the blood pump.
•Clamp the venous bloodline.
•Don’t return the blood in the extracorporeal circuit to the patient.
•Quickly position the patient in a left-sided recumbent position, with
the head and chest bent downward.
•Administer 100% oxygen by mask or endotracheal tube.
•It may be necessary to evacuate air from the ventricle or atrium.
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com

32. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

33. Manifestations of disequilibrium syndrome
•Milder forms of the syndrome and early manifestations of the severe
form: nausea, vomiting, restlessness, and headache.
•More severe manifestations include seizures, obtundation, and coma.
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com

34. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

35. Disequilibrium syndrome in acute and chronic
dialysis
•Disequilibrium syndrome occurs more in acutely uremic patients who
are dialyzed aggressively.
•Patients undergoing chronic dialysis may still develop milder
manifestations of the disease.
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com

36. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

37. Pathogenesis of disequilibrium syndrome
1. Rapid lowering of plasma osmolarity
2. Change is cerebrospinal fluid (CSF) pH: Paradoxical CSF acidosis
3. Idiogenic osmoles effect
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
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38. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
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(3) Shift of water
to brain
intracellular space
(1)
Urea
diffusion
(2)
Urea serum level
decreases and
plasma becomes
hypotonic with
respect to the
brain cells
Intravascular
space

39. Pathogenesis of disequilibrium syndrome
1. Rapid lowering of plasma osmolarity
2. Change is cerebrospinal fluid (CSF) pH: Paradoxical CSF acidosis
3. Idiogenic osmoles effect
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
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40. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
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(1)
Rapid
bicarbonate
diffusion
(2a)
HCO3
−
+ H
+
→
H
2CO
3 →
CO
2 + H
2O
Intravascular
space
CO
2 + H
2O → H
2CO
3
→ HCO3
−
+ H
+

(4)
Protein + Na
+
(5)
Protein + H
+

(6)
Na
+
(2b)
HCO3
−
(3)
(7) Na
+
osmose water into brain cells

41. Pathogenesis of disequilibrium syndrome
1. Rapid lowering of plasma osmolarity
2. Change is cerebrospinal fluid (CSF) pH: Paradoxical CSF acidosis
3. Idiogenic osmoles effect
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
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42. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
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Intravascular space
H
+

(5)
Protein + Na
+
(6)
Protein + H
+

(7)
Na
+
(8) Na
+
osmose water into brain cells
Idiogenic
osmoles
(3) Osmoles osmose water into brain cells
(4)
(1)
Urea
diffusion
(2)
Urea serum level decreases
and plasma becomes
hypotonic with respect to
idiogenic osmoles
in the brain cells

43. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

44. Diagnosis of disequilibrium syndrome
•Dialysis disequilibrium syndrome lacks a definitive diagnostic test.
•Its diagnosis depends on clinical presentation.
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com

45. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

46. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
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Mild disequilibrium Severe disequilibrium (seizures and coma)
•Symptomatic treatment.
•The blood and dialysate flow rates should be
reduced.
•The ultrafiltration rate should be reduced too.
•Glucose or hypertonic sodium chloride solutions
may be given.
•Early termination of the dialysis session should
be considered, especially in acutely uremic
patients.
•Dialysis should be stopped.
•First aid measures for seizure management must
be taken.
•Intravenous mannitol, hypertonic saline, or
glucose may be of benefit.
•If seizures and coma are due to disequilibrium
syndrome, the patient should improve within 24
hours.
Exclude other causes of seizures: Other causes of seizures in dialysis patients rather than disequilibrium
syndrome should be excluded as early as possible, especially if the patient does not improve within a 24-
hour period.

47. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

48. In case of acute dialysis for a patient with
acute uremia
•Avoid prescribing aggressive dialysis sessions
•Urea reduction ratio (URR) target 30-40%
•Severely acidotic patients: initial dialysis treatments should be with
reduced dialysate bicarbonate
•Avoid using low dialysate sodium (>2–3 mmol/L less than the plasma
sodium level)
•Hypernatremic patients: uremia and hypernatremia correction should
not be attempted simultaneously.
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
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49. In case of chronic dialysis
•Using sodium dialysate of at least 140 mmol/L can minimize the
incidence of disequilibrium syndrome.
•Sodium modeling: Although it decreases the occurrence of
disequilibrium syndrome, it has many drawbacks.
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
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50. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

51. Causes of seizures during hemodialysis session
•Disequilibrium syndrome.
•Severe hypotension.
•Hypertensive encephalopathy.
•Metabolic causes: hypoglycemia, hypocalcemia, hypernatremia, or
hyponatremia.
•Intracranial hemorrhage.
•Air embolism.
•Aluminum encephalopathy.
•Drugs that lower the seizure threshold.
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
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52. Talk Outline: Chapter 8
Complications During Hemodialysis: Part 2
•Muscle cramps:
oTiming
oPathogenesis
oManagement
oPrevention
•Hemolysis:
oCauses
oManifestations
oManagement
•Air embolism:
oSites of air entry
oManifestations
oManagement
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
•Disequilibrium syndrome:
oManifestations
oAcute and chronic dialysis
oPathogenesis
oDiagnosis
oManagement
oPrevention
•Seizures:
oCauses
oManagement

53. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
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Immediate management:
- Terminate the dialysis session.
- Secure vascular access.
- Ensure the patient is not in danger
of injury and is in a secure setting.
- Administer intravenous fluids and
oxygen as required.
- The majority of seizures resolve
spontaneously within five minutes.
If a patient continues to seize:
- Achieve airway protection and
patient stabilization.
- Administering intravenous
benzodiazepines is the treatment of
choice to terminate the seizures.
- Refer the patient for neurology
consultation.
Immediate urgent management of seizures
during hemodialysis session

54. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Immediate management:
- Terminate the dialysis session.
- Secure vascular access.
- Ensure the patient is not in danger
of injury and is in a secure setting.
- Administer intravenous fluids and
oxygen as required.
- The majority of seizures resolve
spontaneously within five minutes.
If a patient continues to seize:
- Achieve airway protection and
patient stabilization.
- Administering intravenous
benzodiazepines is the treatment of
choice to terminate the seizures.
- Refer the patient for neurology
consultation.
Immediate urgent management of seizures
during hemodialysis session
After the seizure has been remitted, try to find the cause

55. Thank You