Frank Kelly Cases

Question 1

What are the symptoms of hardwater syndrome?

Answer 1

Hypertension, hypercalcaemia

Question 2

What are the limits for standard dialysis water purity?

Answer 2

<100CFU/ml, <0.25EU/ml for endotoxin

Ultrapure <0.1CFU/ml, <0.03EU/ml for endotoxin

Question 3

What are the features of a Type A dialyser reaction?

Answer 3

Usually occurs in the first therapy

First 10 minutes, no later than 30 minutes into treatment

Question 4

What are the features of a Type B dialyser reaction?

Answer 4

3-5% of patients on new cellulose based dialyser
Complement mediated
Usually >15 minutes into treatment
Tends to ease with treatment continuation

Question 5

What are the potential causes of haemolytic reactions on HD?

Answer 5

Hypotonic dialysate
Overheated dialysate
High chloramine
Other chemical contaminants (Cu, nitrate)
Residual disinfectants)
Kinked tubing

Question 6

How do you manage the haemolytic reaction on HD?

Answer 6

Stop pump
Do not return blood
Hospitalise
Emergent HD; new machine
Investigate source

Question 7

What are the features of air embolism on HD?

Answer 7

Problem with arterial connection or tubing, empty IV bag
Sitting = CNS symptoms
Lying = Cardiopulmonary
Churning sound on auscultation on chest

Question 8

How do you manage an air embolism?

Answer 8

Clamp line
Stop blood pump
Left lateral Trendelenberg
100% O2