Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect?
A. Infection
B. Disequilibrium syndrome
C. Air embolism
D. Acute hemolysis
Correct Answer: B. Disequilibrium syndrome
Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the blood. This can lead to cerebral edema and increased intracranial pressure (ICP). Signs and symptoms include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.
Option A: Patients who undergo dialysis treatment have an increased risk for getting an infection. Hemodialysis patients are at high risk for infection because the process of hemodialysis requires frequent use of catheters or insertion of needles to access the bloodstream.
Option C: Air embolism during renal dialysis is extremely rare because of the safeguards built into the apparatus and procedures currently used. Air enters the circuit through the infusion bottle, the heparin syringe or line, or the blood pump insert. Emergency treatment with posture, oxygen, dextran infusion, and dexamethasone was apparently successful in reversing some of the manifestations. Prevention depends partly on better design of equipment and partly on the incorporation in the hemodialysis circuit of devices which detect air and prevent it from reaching the patient.
Option D: Uncommonly, patients on dialysis can have severe (at times life-threatening) hemolysis. These patients fit into either of two categories, depending on whether hemolysis involves all or the majority of the patients being dialyzed under similar circumstances in a given dialysis center or whether the hemolysis is patient specific. Hemolysis in the former is often the result of water-borne toxins, centralized dialysis equipment failure, or blood tubing defects—whereas in the latter it results from medication or possibly inadequate dialytic therapy.
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