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Renal and Electrolytes
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Dialysis describes the use of a semipermeable membrane that acts as a filter with a solution to regulate the fluid and electrolytes in the blood. There are three main forms: Haemodialysis: Uses an AV fistula (between radial artery and cephalic vein) with blood flowing from one side of a semipermeable membrane with dialysis solution flowing in the opposite direction. Requires multiple treatments per week. Complications include hypotension, infection, thrombosis (from AV fistula) and dialysis disequilibrium syndrome (cerebral oedema).Haemofiltration: Blood flows through a machine through a semipermeable membrane but no dialysis solution is used. Positive hydrostatic pressure pushes fluid across. Complications are similar to haemodialysis but haemofiltration causes less hypotension.Peritoneal dialysis: Uses the peritoneum as the semipermeable membrane with access gained via a Tenchkoff catheter through the anterior abdominal wall. Cheaper than haemodialysis/haemofiltration and more flexible for patients. Complications include peritonitis (most commonly due to Staphylococcus epidermidis). Contraindications include peritoneal adhesions, abdominal hernias and colostomy.
Intra-dialytic intracranial pressure monitoring in a patient with lumbo-peritoneal shunt for idiopathic intracranial hypertension
Published in British Journal of Neurosurgery, 2023
W. B. Cato-Addison, L. Ferguson, R. D. Strachan, R. Clark, J. S. Murray, I. Moore
Dialysis disequilibrium syndrome (DDS) is a rare neurological manifestation of haemodialysis (HD), thought to be due to the promotion of cerebral oedema and characterised by symptoms of raised intracranial pressure. At its most severe, it can lead to death.1 The incidence of DDS is not known although some authors report that it is reducing because dialysis is initiated at lower urea concentrations than previously.2,3 We present a case of DDS supported by evidence of raised intra-dialytic intracranial pressure (ICP). A novel manoeuvre to reduce her ICP during dialysis resolved her symptoms.