Dialysis

Question 1

7 serious causes of hypotension during dialysis to consider (rather than just transient needing a small fluid bolus)

Answer 1

Tamponade
Anaphylaxis
MI
Hyperkalemia
Air embolism
Infection
Bleeding

Question 2

Three mechanisms of dialysis related bleeding

Answer 2

Underlying platelet dysfunction
HD related transient thrombocytopenia
Anticoagulation

Question 3

Treatment of bleeding in dialysis patient

Answer 3

DDAVP, cryo, estrogen, transfusion

Protamine to reverse heparin if overanticoagulated

Question 4

What is dialysis disequilibrium syndrome and how is it managed

Answer 4

Cerebral edema due to rapidly changing body fluid composition and osmolality, presents as headache, n/v, muscle cramping usually during or right after HD. Severe will have altered mental status, seizures, coma
Treatment is supportive, usually resolves in a few hours.
No role for hyperosmolar therapy

Question 5

Treatment of fistula puncture site bleeding

Answer 5

Pressure, not occlusion

Can use gel foam soaked in thrombin, tissue adhesive

Question 6

What is branham sign

Answer 6

Drop in HR with temporary occlusion of HD access site, signals high output heart failure

Question 7

Most common organisms in vascular access site infection

Answer 7

Staph and strep. Can also see gram negative

Question 8

Treatment vascular access site infection

Answer 8

Blood cultures, culture access site

Vanco and ceftriaxone or gentamycin for GN

Question 9

Bugs seen in peritoneal dialysis related peritonitis

Answer 9

Staph, strep, GN, rarely anaerobes and fungi, suspect perforation if multiple organisms grow

Question 10

Clinical presentation of PD associated peritonitis

Answer 10

Fever, abdo pain, cloudy PD fluid

Cut off of >100 WBC or 50% neutrophils (lower than the 250 WBC cut off for SBP)

Question 11

Treatment of HD associated PD

Answer 11

Intraperitoneal antibiotics, vanco and ceftriaxone