Uremic encephalopathy is an organic brain disorder caused by the accumulation of toxins in the brain that are normally cleared by the kidneys. It develops in patients with renal failure when creatinine clearance falls below 15 mL/min. Symptoms range from mild symptoms like fatigue to more severe symptoms like seizures and coma. Treatment involves correcting metabolic disturbances through dialysis or renal transplantation, which typically leads to improvement, though EEG findings may not fully normalize for months. Ongoing management focuses on adequate dialysis and treatment of underlying conditions.
Uremic encephalopathy occurs when toxins that are normally cleared by the kidneys build up in the bloodstream due to kidney failure. It causes a range of neurological symptoms from mild issues like fatigue to severe problems like seizures and coma. The condition develops when kidney function declines to the point that creatinine clearance levels fall below 15 mL/min. While the exact cause is unknown, it involves the accumulation of various toxins in the brain that disrupts cell metabolism and function. Prompt treatment with dialysis or kidney transplantation can reverse the neurological symptoms.
This document discusses peripheral neuropathy, including:
1. It defines peripheral neuropathy and describes the different types that can affect motor, sensory, or autonomic nerves.
2. It outlines various causes of peripheral neuropathies including hereditary, infectious, inflammatory, metabolic, toxic, and more.
3. It describes the clinical presentations of different types of peripheral neuropathies based on the affected nerves and provides examples.
This document discusses hemorrhagic stroke, specifically intracerebral hemorrhage. It defines intracerebral hemorrhage as bleeding within the brain tissue itself, accounting for 15% of strokes. Risk factors include hypertension and amyloid angiopathy. Clinical presentation includes sudden onset of focal neurological deficits like weakness or seizures. Diagnostics include CT scans. Prognosis is poor with 50% mortality at 1 year. Management focuses on controlling blood pressure, treating increased intracranial pressure, preventing seizures and infections. Surgical options include removing the hemorrhage via aspiration or craniotomy. Subarachnoid hemorrhage is also discussed as bleeding into the subarachnoid space, often from
Cerebral herniation occurs when brain tissue shifts from its normal position inside the skull due to swelling. This is usually caused by head injury, stroke, bleeding or tumors. There are several types of herniation including subfalcine, transtentorial, uncal, and cerebellar tonsillar herniation. Management involves reducing intracranial pressure through surgical removal of mass lesions, ventricular drainage, medical therapies like hyperventilation, hyperosmotic agents, induced hypertension, barbiturate coma or hypothermia, and in severe cases decompressive craniectomy. The condition progresses through stages as herniation worsens and involves specific neurological exam findings at each stage.
This document discusses hemorrhagic stroke, including intracerebral and subarachnoid hemorrhage. Intracerebral hemorrhage is caused by bleeding into the brain tissue and accounts for 10-15% of strokes. It has high mortality, especially if the patient is in a coma. Subarachnoid hemorrhage is caused by bleeding into the subarachnoid space, often due to ruptured aneurysms. Both require imaging like CT or MRI to diagnose and determine treatment, which may include surgery to remove hematomas or clip aneurysms. Complications include cerebral vasospasm, rebleeding, and hydrocephalus. Secondary stroke prevention focuses on controlling risk factors and treating
This document provides an overview of peripheral neuropathies. It discusses that peripheral neuropathies can involve sensory nerves, motor nerves, or both, and may affect single or multiple nerves. The document then covers the clinical presentation and classification of different types of neuropathies, including those that primarily affect the cell body, myelin, or axon. It also lists common causes of peripheral neuropathies like diabetes, paraproteinemia, alcohol misuse, and discusses their prevalence. The temporal course, symptoms, and assessment of peripheral neuropathies are discussed in detail.
Intracerebral hemorrhage is more common in Asian countries and incidence increases with age. It has a high mortality rate, especially when located in the brainstem. Clinical presentation includes altered mental status, headache, nausea and focal neurological deficits depending on the location of bleeding in the brain. CT scan is used to diagnose and determine the size and location of hemorrhage. Treatment focuses on controlling blood pressure, reducing ICP and treating the underlying cause.
Uremic encephalopathy occurs when toxins that are normally cleared by the kidneys build up in the bloodstream due to kidney failure. It causes a range of neurological symptoms from mild issues like fatigue to severe problems like seizures and coma. The condition develops when kidney function declines to the point that creatinine clearance levels fall below 15 mL/min. While the exact cause is unknown, it involves the accumulation of various toxins in the brain that disrupts cell metabolism and function. Prompt treatment with dialysis or kidney transplantation can reverse the neurological symptoms.
This document discusses peripheral neuropathy, including:
1. It defines peripheral neuropathy and describes the different types that can affect motor, sensory, or autonomic nerves.
2. It outlines various causes of peripheral neuropathies including hereditary, infectious, inflammatory, metabolic, toxic, and more.
3. It describes the clinical presentations of different types of peripheral neuropathies based on the affected nerves and provides examples.
This document discusses hemorrhagic stroke, specifically intracerebral hemorrhage. It defines intracerebral hemorrhage as bleeding within the brain tissue itself, accounting for 15% of strokes. Risk factors include hypertension and amyloid angiopathy. Clinical presentation includes sudden onset of focal neurological deficits like weakness or seizures. Diagnostics include CT scans. Prognosis is poor with 50% mortality at 1 year. Management focuses on controlling blood pressure, treating increased intracranial pressure, preventing seizures and infections. Surgical options include removing the hemorrhage via aspiration or craniotomy. Subarachnoid hemorrhage is also discussed as bleeding into the subarachnoid space, often from
Cerebral herniation occurs when brain tissue shifts from its normal position inside the skull due to swelling. This is usually caused by head injury, stroke, bleeding or tumors. There are several types of herniation including subfalcine, transtentorial, uncal, and cerebellar tonsillar herniation. Management involves reducing intracranial pressure through surgical removal of mass lesions, ventricular drainage, medical therapies like hyperventilation, hyperosmotic agents, induced hypertension, barbiturate coma or hypothermia, and in severe cases decompressive craniectomy. The condition progresses through stages as herniation worsens and involves specific neurological exam findings at each stage.
This document discusses hemorrhagic stroke, including intracerebral and subarachnoid hemorrhage. Intracerebral hemorrhage is caused by bleeding into the brain tissue and accounts for 10-15% of strokes. It has high mortality, especially if the patient is in a coma. Subarachnoid hemorrhage is caused by bleeding into the subarachnoid space, often due to ruptured aneurysms. Both require imaging like CT or MRI to diagnose and determine treatment, which may include surgery to remove hematomas or clip aneurysms. Complications include cerebral vasospasm, rebleeding, and hydrocephalus. Secondary stroke prevention focuses on controlling risk factors and treating
This document provides an overview of peripheral neuropathies. It discusses that peripheral neuropathies can involve sensory nerves, motor nerves, or both, and may affect single or multiple nerves. The document then covers the clinical presentation and classification of different types of neuropathies, including those that primarily affect the cell body, myelin, or axon. It also lists common causes of peripheral neuropathies like diabetes, paraproteinemia, alcohol misuse, and discusses their prevalence. The temporal course, symptoms, and assessment of peripheral neuropathies are discussed in detail.
Intracerebral hemorrhage is more common in Asian countries and incidence increases with age. It has a high mortality rate, especially when located in the brainstem. Clinical presentation includes altered mental status, headache, nausea and focal neurological deficits depending on the location of bleeding in the brain. CT scan is used to diagnose and determine the size and location of hemorrhage. Treatment focuses on controlling blood pressure, reducing ICP and treating the underlying cause.
This document summarizes information about epilepsy and seizures. It defines epilepsy as recurrent seizures and describes different types of seizures including focal-onset, generalized-onset, tonic-clonic, absence, myoclonic, atonic, and tonic seizures. Causes, pathophysiology, diagnosis and treatment options are discussed. Treatment involves antiepileptic medications as first-line treatment, with surgery, neurostimulation or dietary therapies as options for refractory cases. Potential risks and complications of treatments are also summarized.
A 55-year-old male with a history of chronic alcohol use presented with altered mental status and black stools. On examination, he was conscious but confused with signs of liver dysfunction. The main differential diagnoses were hepatic encephalopathy, alcohol withdrawal, cerebrovascular accident, meningitis, and metabolic encephalopathy. Hepatic encephalopathy was suggested as the leading diagnosis given the history of chronic liver disease and characteristic clinical features including fluctuating neurological signs and asterixis. Treatment focused on identifying and removing precipitating factors while providing supportive care and medications to reduce ammonia like lactulose.
This document discusses peripheral neuropathies and their causes and characteristics. It covers different types of neuropathies including mononeuropathies, mononeuritis multiplex, and polyneuropathies. Common causes of polyneuropathies discussed include inherited conditions, metabolic/endocrine disorders, toxins, infections, inflammation, and vitamin deficiencies. Signs and symptoms and investigative approaches are also summarized.
This document discusses renal and hepatic encephalopathy. It defines uremic encephalopathy as a brain disorder that occurs in patients with untreated or inadequately treated kidney disease. Symptoms range from mild to severe and fluctuate depending on kidney function. Uremic toxins that accumulate due to renal dysfunction are a primary cause. Treatment involves optimizing dialysis to adequately remove toxins. Other types of encephalopathy discussed include dialysis dementia, central pontine myelinolysis, seizures, and restless leg syndrome. Causes, clinical features, diagnosis and management are described for each condition.
This document discusses peripheral neuropathy, including:
- The clinical effects of motor, sensory, and autonomic nerve injury, including weakness, loss of sensation, and autonomic dysfunction.
- The two main types of peripheral neuropathies - axonopathies which affect nerve fibers, and myelinopathies which affect the myelin sheath.
- The many potential causes of peripheral neuropathy both inherited and acquired, such as diabetes, toxins, infections, inflammation and genetic disorders. A thorough history and examination is needed to determine the underlying cause.
This document defines acute kidney injury (AKI), formerly known as acute renal failure (ARF), and discusses its causes, diagnosis, and management. AKI is defined based on increases in serum creatinine and decreases in urine output. The main causes of AKI are pre-renal (decreased renal blood flow), renal (intrinsic kidney injury), and post-renal (urinary tract obstruction). Common etiologies include acute tubular necrosis, glomerulonephritis, and acute interstitial nephritis. Diagnosis involves laboratory and imaging tests. Management focuses on treating the underlying cause, fluid management, and potentially renal replacement therapy. Prognosis depends on the severity and reversibility of the kidney injury
This document discusses sodium metabolism and disorders of sodium concentration. It provides details on:
- Water distribution in the body and fluid compartments
- Causes and types of hyponatremia, including hypovolemic, hypervolemic, and euvolemic hyponatremia
- Evaluation and management of hyponatremia, including treatment based on severity and rate of sodium correction
- Causes and clinical features of hypernatremia
The document is a comprehensive review of sodium disorders and approaches to diagnosis and treatment of hypo- and hypernatremia.
This document provides an overview of peripheral neuropathy, including:
1) It defines peripheral neuropathy and outlines the anatomy of the peripheral nervous system.
2) It classifies peripheral neuropathies based on anatomy, nerve fiber diameter, and pathological basis.
3) It discusses the key differences between axonopathies and myelinopathies, including typical symptoms and prognosis.
This document discusses hypertensive urgency and emergency. Hypertensive urgency is defined as systolic BP >200 mm Hg or diastolic BP >120 mm Hg without end organ damage. Hypertensive emergency is diastolic BP >140 mm Hg with evidence of acute end organ damage. Immediate interventions for patients include assessing BP, elevating the head of bed, administering oxygen, notifying physicians, and documenting status changes. Patients may experience symptoms like headache, confusion, chest pain, or nausea.
Acute Kidney Injury (AKI) is a common complication, affecting 5-7% of hospital admissions and 30% of intensive care unit patients. The top causes of AKI in India are diarrheal diseases, sepsis, malaria, drug toxicity, and hospital-acquired injuries. Biomarkers like cystatin C and kidney injury molecule 1 can help detect AKI earlier than creatinine. Treatment involves fluid resuscitation, eliminating nephrotoxins, and renal replacement therapy for complications like electrolyte imbalances or uremia. Outcomes depend on the underlying cause, with pre-renal and post-renal AKI having a better prognosis than intrinsic renal injury.
This document provides an overview of encephalopathy, including:
- Encephalopathy is defined as an altered mental state caused by diffuse brain dysfunction. Common symptoms include confusion, memory loss, and personality changes.
- There are many potential causes of encephalopathy including metabolic disturbances, toxins, infections, liver failure, inflammation, drugs, demyelination, and lack of oxygen to the brain.
- EEG is often abnormal in encephalopathy, with features including triphasic waves and diffuse slowing correlating to severity of symptoms and impairment of consciousness.
This document discusses encephalitis and Japanese encephalitis. It defines encephalitis as an acute inflammatory process involving brain tissue. Japanese encephalitis is a leading viral cause of encephalitis in Asia, primarily affecting children under 15. It is transmitted via mosquitoes and has an incubation period of 5-15 days. Symptoms include high fever, headache, vomiting and altered mental status.
This document provides guidance on evaluating patients presenting with paraplegia. It outlines the key components of the clinical history and neurological examination needed to determine the cause and level of spinal cord injury. The history should ascertain details of onset and any associated symptoms. The exam focuses on assessing sensory and motor function at different dermatomal and myotomal levels to localize the lesion. Together this information can indicate if the injury is acute, subacute, or chronic, and identify potential etiologies like trauma, infection, inflammation, compression, or vascular causes. The goal is to arrive at a diagnosis and localization of injury within the spinal cord or vertebrae.
This document discusses cerebral edema, which occurs when excess fluid accumulates in the brain tissue leading to increased intracranial pressure. It classifies edema into cytotoxic, vasogenic, and interstitial types based on etiology. Cytotoxic edema results from cellular damage while vasogenic edema stems from blood-brain barrier disruption. Managing cerebral edema focuses on optimizing ventilation, intravenous fluids, blood pressure control, and using osmotherapy agents like mannitol to reduce brain water content.
The document discusses acute kidney injury (AKI), including its causes, diagnosis, and management. It provides details on prerenal, intrinsic, and postrenal forms of AKI. For prerenal AKI, management focuses on correcting the underlying cause, such as volume depletion, and restoring intravascular volume through fluid resuscitation. For intrinsic AKI, identifying and removing nephrotoxic agents is important. Dialysis may be needed for severe AKI with fluid/electrolyte imbalance or uremia.
1) Coma results from disordered arousal of the brain and can be caused by issues with the reticular activating system or bilateral brain damage.
2) Levels of consciousness between fully awake and comatose include stupor, obtundation, and drowsiness. The Glasgow Coma Scale is used to assess level of consciousness.
3) Causes of coma include issues like ischemia, toxins, metabolic disturbances, infections, trauma, and structural brain lesions. Proper assessment involves stabilizing the patient, considering potential causes, performing a neurological exam including the Glasgow Coma Scale, and considering further testing if needed.
The document defines various types of strokes and transient ischemic attacks. It discusses the epidemiology, risk factors, clinical features, investigations, and management of strokes. The main types are ischemic and hemorrhagic strokes. Investigations include brain imaging like CT scan and MRI to identify the type of stroke and underlying causes. Treatment focuses on minimizing brain damage, preventing complications, rehabilitation, and reducing the risk of recurrence.
Derived from Greek word “enkephalos”- meaning brain.
“Pathos” meaning is disease.
The term “encephalopathy” is defined as altered mental status as a result of a diffuse disturbance of brain function.
NEUROLOGICAL MANIFESTION OF RENAL DISEASENeurologyKota
This document summarizes various neurological complications that can occur in patients with renal disease. It discusses central nervous system complications such as encephalopathy, dementia, and cerebrovascular disease. It describes the pathophysiology and treatment of various types of encephalopathy including uremic encephalopathy, Wernicke's encephalopathy, and dialysis encephalopathy. It also discusses peripheral nervous system complications including mononeuropathy, polyneuropathy, and myopathy.
This document summarizes information about epilepsy and seizures. It defines epilepsy as recurrent seizures and describes different types of seizures including focal-onset, generalized-onset, tonic-clonic, absence, myoclonic, atonic, and tonic seizures. Causes, pathophysiology, diagnosis and treatment options are discussed. Treatment involves antiepileptic medications as first-line treatment, with surgery, neurostimulation or dietary therapies as options for refractory cases. Potential risks and complications of treatments are also summarized.
A 55-year-old male with a history of chronic alcohol use presented with altered mental status and black stools. On examination, he was conscious but confused with signs of liver dysfunction. The main differential diagnoses were hepatic encephalopathy, alcohol withdrawal, cerebrovascular accident, meningitis, and metabolic encephalopathy. Hepatic encephalopathy was suggested as the leading diagnosis given the history of chronic liver disease and characteristic clinical features including fluctuating neurological signs and asterixis. Treatment focused on identifying and removing precipitating factors while providing supportive care and medications to reduce ammonia like lactulose.
This document discusses peripheral neuropathies and their causes and characteristics. It covers different types of neuropathies including mononeuropathies, mononeuritis multiplex, and polyneuropathies. Common causes of polyneuropathies discussed include inherited conditions, metabolic/endocrine disorders, toxins, infections, inflammation, and vitamin deficiencies. Signs and symptoms and investigative approaches are also summarized.
This document discusses renal and hepatic encephalopathy. It defines uremic encephalopathy as a brain disorder that occurs in patients with untreated or inadequately treated kidney disease. Symptoms range from mild to severe and fluctuate depending on kidney function. Uremic toxins that accumulate due to renal dysfunction are a primary cause. Treatment involves optimizing dialysis to adequately remove toxins. Other types of encephalopathy discussed include dialysis dementia, central pontine myelinolysis, seizures, and restless leg syndrome. Causes, clinical features, diagnosis and management are described for each condition.
This document discusses peripheral neuropathy, including:
- The clinical effects of motor, sensory, and autonomic nerve injury, including weakness, loss of sensation, and autonomic dysfunction.
- The two main types of peripheral neuropathies - axonopathies which affect nerve fibers, and myelinopathies which affect the myelin sheath.
- The many potential causes of peripheral neuropathy both inherited and acquired, such as diabetes, toxins, infections, inflammation and genetic disorders. A thorough history and examination is needed to determine the underlying cause.
This document defines acute kidney injury (AKI), formerly known as acute renal failure (ARF), and discusses its causes, diagnosis, and management. AKI is defined based on increases in serum creatinine and decreases in urine output. The main causes of AKI are pre-renal (decreased renal blood flow), renal (intrinsic kidney injury), and post-renal (urinary tract obstruction). Common etiologies include acute tubular necrosis, glomerulonephritis, and acute interstitial nephritis. Diagnosis involves laboratory and imaging tests. Management focuses on treating the underlying cause, fluid management, and potentially renal replacement therapy. Prognosis depends on the severity and reversibility of the kidney injury
This document discusses sodium metabolism and disorders of sodium concentration. It provides details on:
- Water distribution in the body and fluid compartments
- Causes and types of hyponatremia, including hypovolemic, hypervolemic, and euvolemic hyponatremia
- Evaluation and management of hyponatremia, including treatment based on severity and rate of sodium correction
- Causes and clinical features of hypernatremia
The document is a comprehensive review of sodium disorders and approaches to diagnosis and treatment of hypo- and hypernatremia.
This document provides an overview of peripheral neuropathy, including:
1) It defines peripheral neuropathy and outlines the anatomy of the peripheral nervous system.
2) It classifies peripheral neuropathies based on anatomy, nerve fiber diameter, and pathological basis.
3) It discusses the key differences between axonopathies and myelinopathies, including typical symptoms and prognosis.
This document discusses hypertensive urgency and emergency. Hypertensive urgency is defined as systolic BP >200 mm Hg or diastolic BP >120 mm Hg without end organ damage. Hypertensive emergency is diastolic BP >140 mm Hg with evidence of acute end organ damage. Immediate interventions for patients include assessing BP, elevating the head of bed, administering oxygen, notifying physicians, and documenting status changes. Patients may experience symptoms like headache, confusion, chest pain, or nausea.
Acute Kidney Injury (AKI) is a common complication, affecting 5-7% of hospital admissions and 30% of intensive care unit patients. The top causes of AKI in India are diarrheal diseases, sepsis, malaria, drug toxicity, and hospital-acquired injuries. Biomarkers like cystatin C and kidney injury molecule 1 can help detect AKI earlier than creatinine. Treatment involves fluid resuscitation, eliminating nephrotoxins, and renal replacement therapy for complications like electrolyte imbalances or uremia. Outcomes depend on the underlying cause, with pre-renal and post-renal AKI having a better prognosis than intrinsic renal injury.
This document provides an overview of encephalopathy, including:
- Encephalopathy is defined as an altered mental state caused by diffuse brain dysfunction. Common symptoms include confusion, memory loss, and personality changes.
- There are many potential causes of encephalopathy including metabolic disturbances, toxins, infections, liver failure, inflammation, drugs, demyelination, and lack of oxygen to the brain.
- EEG is often abnormal in encephalopathy, with features including triphasic waves and diffuse slowing correlating to severity of symptoms and impairment of consciousness.
This document discusses encephalitis and Japanese encephalitis. It defines encephalitis as an acute inflammatory process involving brain tissue. Japanese encephalitis is a leading viral cause of encephalitis in Asia, primarily affecting children under 15. It is transmitted via mosquitoes and has an incubation period of 5-15 days. Symptoms include high fever, headache, vomiting and altered mental status.
This document provides guidance on evaluating patients presenting with paraplegia. It outlines the key components of the clinical history and neurological examination needed to determine the cause and level of spinal cord injury. The history should ascertain details of onset and any associated symptoms. The exam focuses on assessing sensory and motor function at different dermatomal and myotomal levels to localize the lesion. Together this information can indicate if the injury is acute, subacute, or chronic, and identify potential etiologies like trauma, infection, inflammation, compression, or vascular causes. The goal is to arrive at a diagnosis and localization of injury within the spinal cord or vertebrae.
This document discusses cerebral edema, which occurs when excess fluid accumulates in the brain tissue leading to increased intracranial pressure. It classifies edema into cytotoxic, vasogenic, and interstitial types based on etiology. Cytotoxic edema results from cellular damage while vasogenic edema stems from blood-brain barrier disruption. Managing cerebral edema focuses on optimizing ventilation, intravenous fluids, blood pressure control, and using osmotherapy agents like mannitol to reduce brain water content.
The document discusses acute kidney injury (AKI), including its causes, diagnosis, and management. It provides details on prerenal, intrinsic, and postrenal forms of AKI. For prerenal AKI, management focuses on correcting the underlying cause, such as volume depletion, and restoring intravascular volume through fluid resuscitation. For intrinsic AKI, identifying and removing nephrotoxic agents is important. Dialysis may be needed for severe AKI with fluid/electrolyte imbalance or uremia.
1) Coma results from disordered arousal of the brain and can be caused by issues with the reticular activating system or bilateral brain damage.
2) Levels of consciousness between fully awake and comatose include stupor, obtundation, and drowsiness. The Glasgow Coma Scale is used to assess level of consciousness.
3) Causes of coma include issues like ischemia, toxins, metabolic disturbances, infections, trauma, and structural brain lesions. Proper assessment involves stabilizing the patient, considering potential causes, performing a neurological exam including the Glasgow Coma Scale, and considering further testing if needed.
The document defines various types of strokes and transient ischemic attacks. It discusses the epidemiology, risk factors, clinical features, investigations, and management of strokes. The main types are ischemic and hemorrhagic strokes. Investigations include brain imaging like CT scan and MRI to identify the type of stroke and underlying causes. Treatment focuses on minimizing brain damage, preventing complications, rehabilitation, and reducing the risk of recurrence.
Derived from Greek word “enkephalos”- meaning brain.
“Pathos” meaning is disease.
The term “encephalopathy” is defined as altered mental status as a result of a diffuse disturbance of brain function.
NEUROLOGICAL MANIFESTION OF RENAL DISEASENeurologyKota
This document summarizes various neurological complications that can occur in patients with renal disease. It discusses central nervous system complications such as encephalopathy, dementia, and cerebrovascular disease. It describes the pathophysiology and treatment of various types of encephalopathy including uremic encephalopathy, Wernicke's encephalopathy, and dialysis encephalopathy. It also discusses peripheral nervous system complications including mononeuropathy, polyneuropathy, and myopathy.
Nervous system / neurological involvement in ckdManish Singla
This document discusses nervous system manifestations of chronic kidney disease (CKD). It covers several topics:
1. Neurological complications are common in CKD, affecting the central and peripheral nervous systems. Patients on dialysis tend to have reduced strength, activity levels and exercise capacity compared to healthy individuals.
2. Specific conditions discussed include peripheral neuropathy, carpal tunnel syndrome, autonomic neuropathy, cognitive dysfunction, uremic encephalopathy, dialysis disequilibrium syndrome, stroke, and myopathy.
3. Pathophysiology involves the retention of toxins in CKD that can damage nerves. Treatment focuses on renal replacement therapy through dialysis or transplantation to remove toxins from the body.
Brain-kidney crosstalk: The Effect of Acute Kidney Injury on the Brain and Ce...Mahidol University
Acute kidney injury (AKI) can affect brain function and cerebral health through several mechanisms. AKI causes systemic inflammation which increases cytokines in the brain and disrupts the blood-brain barrier. It also impacts neurotransmitter levels, endocrine function, acid-base balance, and brain water content. These disruptions can range from minor motor impairment to coma. Dialysis for AKI patients with brain injury requires modifications to prevent hypotension and intracellular acidosis which could further damage brain cells.
This document discusses the bidirectional relationship between the brain and kidneys. It begins by outlining how signals from the central nervous system regulate renal blood flow, filtration, and sodium handling, while the kidneys also send signals to the brain and contralateral kidney. It then examines how acute brain injuries can lead to acute kidney injury through mechanisms like neuroinflammation, increased sympathetic activity, and disturbances to the hypothalamic-pituitary axis. Finally, it explores how acute kidney injury can also impact cerebral function by disrupting blood-brain barriers and stimulating inflammatory responses in the brain.
By the end of this session, learners will be able to:
Develop and refine a differential diagnosis for peripheral neuropathy
Discuss the workup for common & typical cases
Perform a comprehensive diabetic foot exam
by ADA/NDEP standards
Treat painful peripheral neuropathy
Chronic kidney disease results from the chronic and progressive loss of renal function and reduction in functioning nephrons. This leads to retention of waste products and toxins as well as hormonal and nutritional deficiencies. Clinical manifestations include fatigue, edema, hypertension, pruritus, and cognitive issues. Long-term complications involve multiple organ systems like the heart, bones, immune system, and brain. Management focuses on controlling risk factors, reducing retention and toxicity, and treating complications.
This document summarizes evidence-based treatment recommendations for uremic bleeding. Uremic bleeding is a complication of renal failure caused by multiple factors including dysfunctional von Willebrand factor, accumulation of uremic toxins, anemia, and platelet dysfunction. Treatment options aim to address specific pathophysiological mechanisms and may include erythropoietin to increase red blood cell count, cryoprecipitate to provide clotting factors, desmopressin to release von Willebrand factor and factor VIII, and estrogens to decrease nitric oxide levels and increase platelet aggregation. Early prevention and treatment that targets multiple disease mechanisms may most effectively manage uremic bleeding.
Hypertensive Encephalopathy and Emergenciessazzad92
This document discusses hypertensive encephalopathy and hypertensive emergencies. It defines hypertensive encephalopathy as a condition caused by very high blood pressure that results in neurological symptoms. It describes the pathogenesis, symptoms, investigations, diagnosis, and treatment, which involves slowly lowering blood pressure over 24-48 hours. Hypertensive emergencies involve acute severe blood pressure elevations that cause end organ damage and require admission and rapid blood pressure control within hours to prevent further damage. The document outlines the clinical features, diagnosis, and treatments for hypertensive emergencies depending on the affected organ.
The document discusses various known and unknown uremic toxins that accumulate in patients with chronic kidney disease. It describes small water-soluble compounds like urea, guanidines, oxalate, phosphorus, and metabolic acids. It also covers protein-bound compounds such as p-cresol, homocysteine, and discusses how their removal during dialysis is hampered due to strong protein binding. The document provides details on the effects of these uremic toxins and potential strategies to enhance their removal or reduce their levels.
This document provides an overview of acute kidney injury (AKI), including definitions, causes, presentations, investigations, and management. It discusses the most common causes of AKI as being acute tubular necrosis, prerenal disease, and acute injury superimposed on chronic kidney disease. It also reviews peritoneal dialysis peritonitis and includes summaries of 6 case examples involving AKI, peritonitis, myeloma, vasculitis, and renal artery stenosis. Key points for managing renal patients are highlighted such as the importance of a baseline creatinine and treating peritonitis in a time-critical manner.
Acute renal failure (ARF) is defined as a rapid decline in kidney function over hours or days. It can be caused by decreased blood flow to the kidneys, damage or toxicity to the kidney cells. Symptoms include decreased urine output, fatigue, nausea and fluid retention. Treatment involves treating the underlying cause, fluid management, and potentially dialysis. Chronic renal failure (CRF) is the gradual, permanent loss of kidney function over months or years due to conditions like diabetes or hypertension. It leads to a buildup of waste products and imbalances in electrolytes. Management includes dietary modifications, medication, and long-term dialysis or transplant.
This document discusses altered mental status and provides information on understanding consciousness, conducting an examination of a patient with impaired consciousness, generating a differential diagnosis, and considering various etiologies that can cause altered mental status including focal brain lesions, diffuse brain injuries, infections, toxicities, and metabolic derangements. Three clinical cases are presented and specific conditions such as hypoxia, hypoglycemia, and hepatic encephalopathy are discussed in further detail.
This document discusses uremic toxins, which are waste products that accumulate in the body when the kidneys are not functioning properly. It is divided into sections on:
- Symptoms of uremia caused by toxin buildup, such as fatigue, loss of concentration, and neuropathy.
- Bergstrom's criteria for identifying uremic toxins.
- Classification of toxins into small water-soluble compounds like urea and creatinine, and protein-bound compounds like phenols and indoles.
- Specific toxins like urea, guanidines, phosphorus, and phenols are discussed in more detail, outlining their effects and relationship to uremic
This document discusses encephalopathy and summarizes key points about its causes, features on EEG, and types. Encephalopathy is defined as altered brain function resulting in impaired consciousness. It can be caused by metabolic, toxic, infectious, hepatic or other issues. On EEG, encephalopathy typically shows generalized slowing and reduced reactivity. Specific patterns like triphasic waves indicate metabolic encephalopathy. The document outlines different types of encephalopathy and their associated EEG findings to help evaluate severity and guide treatment.
Review (ca 2007) of Uremic Toxins Accumulating in Patients with Chronic and End Stage Renal Disease modified from a presentation I gave in Fellow's Grand rounds.
Relied heavily on publications from the EU Toxin Work Group Work, which provides more up to date information:
http://www.uremic-toxins.org/
This document discusses metabolic acidosis, a condition caused by excessive acid production or inadequate removal of acid from the body. It causes a low blood pH (below 7.35). Symptoms are non-specific but can include altered mental status and respiratory changes. Diagnosis involves blood gas analysis showing low bicarbonate and pH. The anion gap is used to classify types of metabolic acidosis as high, normal, or low. Treatment focuses on resolving the underlying cause while supporting organ function through respiratory and renal compensation mechanisms.
This document discusses acid-base imbalances, including their interpretation based on pH, PCO2 and HCO3 levels. It describes the causes and types of metabolic and respiratory acidosis and alkalosis. Anion gap is explained as a way to determine the cause of acid-base imbalances. Causes of large, normal and small anion gap metabolic acidosis are provided. Compensated versus uncompensated acid-base imbalances are also summarized. Oxygen delivery methods and the management of type 2 diabetes mellitus are briefly covered.
Pulmonary edema is an accumulation of fluid in the lungs that can be either cardiogenic (heart-related) or non-cardiogenic in origin. Cardiogenic pulmonary edema is caused by heart damage or dysfunction leading to inadequate circulation, while non-cardiogenic is caused by toxic inhalation, aspiration, transfusions or infection. Symptoms include cough, difficulty breathing, anxiety and frothy sputum. Treatment involves oxygen, diuretics to reduce fluid, morphine for anxiety, positioning the patient upright, and treating the underlying cause. Nurses monitor vital signs closely, administer treatments, educate the patient, and assess for complications of pulmonary edema and its management.
Uremia refers to the pathological manifestations that occur with severe azotemia or kidney failure. Symptoms of uremia develop as kidney function declines and waste products accumulate in the blood. Chronic kidney disease is defined as kidney damage or decreased kidney function lasting at least 3 months. It is staged based on glomerular filtration rate. Common complications in later stages include fluid and electrolyte abnormalities like hyperkalemia and metabolic acidosis, endocrine disorders like mineral bone disease, and neurological and cardiovascular issues. Dialysis can improve some manifestations of uremia but others may persist or progress despite treatment.
This document discusses various bleeding disorders including:
- Definition as a disorder characterized by spontaneous or excessive bleeding following trauma.
- Etiologies including vessel wall abnormalities (congenital or acquired like vasculitis) and platelet functional disorders.
- Specific disorders discussed in more detail include von Willebrand disease, hemophilia, Bernard-Soulier syndrome, and Glanzmann's thrombasthenia.
- Clinical features, laboratory findings, and treatment approaches are provided for many of the disorders.
This document discusses various bleeding disorders including:
- Definition as a disorder characterized by spontaneous or excessive bleeding following trauma.
- Etiology including vessel wall abnormalities (congenital or acquired like vasculitis) and platelet functional disorders.
- Specific disorders discussed include von Willebrand disease, hemophilia, Bernard-Soulier syndrome, and Glanzmann's thrombasthenia.
- Clinical features, laboratory findings, and treatment options are provided for many of the disorders. The summary highlights the key causes, characteristics, and management approaches for bleeding disorders.
This document provides information on various renal diseases. It discusses that kidney disease can be a silent killer, and that childhood nephrotic syndrome is mostly curable while acute post-streptococcal glomerulonephritis mostly recovers and does not recur. It also notes that hematuria in small children is usually harmless, but that aging can lead to developing kidney disease in most people. Acute renal failure can often be prevented in most cases as well.
This document defines diabetic ketoacidosis (DKA) and describes its causes, pathophysiology, clinical manifestations, diagnostic criteria, and management. DKA is caused by low insulin levels and high counterregulatory hormones, resulting in hyperglycemia, dehydration, and metabolic acidosis. It is often triggered by missed insulin injections, illness, or stress in patients with type 1 diabetes. Treatment involves fluid resuscitation, insulin therapy, electrolyte replacement, and identifying/treating any precipitating causes to reverse the condition.
Neonatal seizures constitute a medical emergency, as they indicate potential brain damage. Subtle seizures are most common in newborns. Hypoglycemia and hypocalcemia are common treatable causes, and should be addressed before initiating anti-seizure medications. Comprehensive management involves emergency care during seizures, diagnostic workup including blood tests and imaging to identify underlying etiologies like hypoxic-ischemic encephalopathy, and psychosocial support for the family.
A 35-year-old man presented with increasing headaches, palpitations, anxiety, and panic attacks over the past six months. His history and examination were consistent with possible conditions including anxiety disorders, hyperthyroidism, and pheochromocytoma. Pheochromocytoma was considered the most likely diagnosis given the classic signs and symptoms. Pheochromocytomas are rare catecholamine-secreting tumors that typically arise from the adrenal medulla or sympathetic ganglia. Diagnostic testing revealed elevated levels of catecholamines and metanephrines confirming the diagnosis of a pheochromocytoma. The patient was started on alpha- and beta-blockers in preparation for surgical removal of the tumor.
Renal disorders in newborns can be congenital or acquired. They are detected prenatally in about 1% of fetuses by ultrasound and in newborns by physical exam or autopsy in less than 1% and 7-9% respectively. Early diagnosis is important to prevent complications. Prenatal diagnosis is usually by ultrasound detecting signs of obstruction. Clinical manifestations vary by type and severity of abnormality and can include dysmorphic features, abdominal masses, ascites, failure to palpate kidneys, and hypertension. Acute renal failure is defined as a creatinine over 1.5 mg/dL and can be functional, intrinsic, or obstructive in nature. Causes include inadequate perfusion,
Neonatal-Seizures diagnosis and managementFelixBoamah3
This document discusses neonatal seizures. It begins by defining seizures and describing the different types seen in neonates. The most common cause is hypoxic ischemic encephalopathy. Other common causes include intraventricular hemorrhage and acute metabolic disorders. Phenobarbital is the first-line treatment, with phenytoin and benzodiazepines as subsequent options. Prognosis depends on the underlying etiology, with focal clonic seizures and those from subarachnoid hemorrhage or late hypocalcemia having better outcomes. Anti-seizure medications should be tapered slowly after seizure control is achieved.
This document provides information about renal diseases. It discusses:
- The importance of the kidney in waste excretion, fluid balance, and other functions.
- Peculiarities of kidney diseases like being asymptomatic, nonspecific symptoms, and few physical signs.
- Definitions of terms like acute renal failure, end stage renal disease, glomerulonephritis, nephrotic syndrome.
- Causes of acute and chronic kidney diseases including diabetes, hypertension, glomerulonephritis.
- Features of specific conditions like IgA nephropathy, Goodpasture's syndrome, polycystic kidney disease.
C. Retinopathy, edema are common finding.
While primary aldosteronism can cause hypokalemia, metabolic alkalosis and high-normal sodium levels, retinopathy and edema are not common findings. The other answer choices are true statements about primary aldosteronism.
The document summarizes urea cycle disorders (UCDs), which are caused by genetic mutations that impair the urea cycle - a pathway in the liver that detoxifies ammonia. The key points are:
1) UCDs can range from severe neonatal presentation with hyperammonemia and coma to late-onset episodic symptoms.
2) Diagnosis involves measuring elevated blood ammonia and amino acid levels. Enzyme analysis or DNA testing can confirm the specific UCD.
3) Treatment focuses on removing ammonia via medications like sodium phenylacetate-sodium benzoate, supplying essential precursors like arginine, and preventing protein intake and catabolism. Vig
Hepatic encephalopathy is a neuropsychiatric syndrome caused by liver dysfunction. It ranges from mild cognitive changes to coma. It is classified into type A (acute liver failure), type B (portosystemic shunts without liver disease), and type C (cirrhosis and chronic liver failure). Diagnosis involves assessing for signs of liver disease and ruling out other causes of mental status changes. Grading scales evaluate symptoms from subtle to coma. Tests for minimal hepatic encephalopathy without overt symptoms include psychometric tests and critical flicker frequency. Treatment focuses on reducing ammonia levels and managing the underlying liver disease.
Seminar presentation by group C 5th year medical student under supervision Dato Imi, endocrine specialist in HRPZ II.
Reference as mentioned at the end of the slide presentation
ROLE OF LAB IN COMMON PEDIATRIC EMERGENCIESMoustafa Rezk
The document discusses several common pediatric emergencies and the role of the laboratory in evaluating and diagnosing them. It provides details on diabetic ketoacidosis (DKA), including causes, symptoms, differential diagnosis, and the 10 most important laboratory tests for evaluation. It also discusses dehydration, noting that volume depletion is more common than dehydration in children, and outlines different types of volume depletion based on sodium levels. Key laboratory tests for assessing dehydration include electrolytes, bicarbonate, potassium, and osmolarity.
This document discusses oral manifestations of various systemic diseases. It covers cardiovascular diseases like congenital heart diseases, rheumatic heart disease, atherosclerosis, and hypertension. It also discusses renal disease, endocrine disorders like disorders of the pituitary and adrenals, and thyroid disorders. Other sections discuss gastrointestinal disorders, collagen vascular diseases, neurological disorders, immunologic diseases, allergies, and respiratory diseases. For each condition, it describes the systemic disease, potential oral manifestations, and considerations for dental management.
- Hypertensive disorders in pregnancy include pre-existing (chronic) hypertension and preeclampsia.
- Pre-eclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. It can lead to serious maternal and fetal complications if not treated properly.
- Treatment for pre-eclampsia involves controlling blood pressure, delivering the baby to resolve symptoms, and monitoring for signs of worsening conditions like eclampsia. Delivery is usually recommended at 36 weeks to balance fetal maturity and risks.
Café Au Lait Spot is A Marker for Pheochromocytoma in Hypertensive Crisis Wit...YasserMohammedHassan1
Café au lait Spot is a marker for pheochromocytoma in hypertensive crisis but with a wide-differential diagnosis. Labetalol may be chosen in hypertensive crisis due to pheochromocytoma.
Asphyxia Neonetrium.pptx for the obstreticsschhataria
This document provides an introduction to birth asphyxia, including definitions, classifications, causes, clinical presentation, investigations, management, complications, and prevention. Birth asphyxia is defined as the inability to initiate or sustain breathing at birth, leading to hypoxic injury. It is currently graded as mild, moderate, or severe based on clinical symptoms and signs. Causes can include factors during pregnancy, delivery, or postpartum. Management involves supportive care like oxygen supplementation as well as controlling seizures and potentially inducing therapeutic hypothermia. Complications can include long term developmental and neurological issues. Prevention focuses on education, identifying risks, early diagnosis and treatment, and rehabilitation.
This presentation covers topics such as history, prevalence, genetics, diagnosis and treatment for Alpha-1 Anti-Trypsin Deficiency (AATD). With more emphasis on the genetics, genes and inheritance pattern, this presentation will explain how alpha-1 anti-trypsin (A1AT) is important for our body and how its absence causes several disorders like emphysema and liver cirrhosis. The presentation explains mainly focusses on the inheritance pattern of the three main alleles PiM, PiS and PiZ and you will come to know how there are several phenotypic as well as genotypic variants for this particular genetic disorder. Hope you will get enough information from the slides about AATD. (This is a ppt that was done with the help of my classmate Soumyadyuti Kundu, initially for her class presentation.)
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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IntroductioinIntroductioin
• Uremic Encephalopathy is an organic brainUremic Encephalopathy is an organic brain
disorder.disorder.
• Uremia is final stage of progressive renalUremia is final stage of progressive renal
insufficiency & resultant multiorgan failure.insufficiency & resultant multiorgan failure.
• It results from accumulating metabolites ofIt results from accumulating metabolites of
proteins & amino acidsproteins & amino acids
4. CONT…CONT…
• No single metabolite has beenNo single metabolite has been
identified as the sole cause of uremia.identified as the sole cause of uremia.
• Uremic encephalopathy (UE) is one ofUremic encephalopathy (UE) is one of
many manifestations of renal failuremany manifestations of renal failure
(RF).(RF).
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• Occurs due to build up of toxins whichOccurs due to build up of toxins which
are normally cleared by kidneys.are normally cleared by kidneys.
• It develops in pts with RF, usuallyIt develops in pts with RF, usually
when creatinine clearance levels fall &when creatinine clearance levels fall &
remain below 15 mL/min.remain below 15 mL/min.
• Manifestations vary fromManifestations vary from
•Mild symptoms (eg, lassitude,Mild symptoms (eg, lassitude,
fatigue) tofatigue) to
•Severe symptoms (eg, seizures,coma).Severe symptoms (eg, seizures,coma).
CONT..
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• Severity & progression depend on rateSeverity & progression depend on rate
of decline in renal function.of decline in renal function.
•Symptoms are usually worse in ARF.Symptoms are usually worse in ARF.
• Prompt identification of uremia as thePrompt identification of uremia as the
cause of encephalopathy is essentialcause of encephalopathy is essential
because symptoms are readilybecause symptoms are readily
reversible following initiation ofreversible following initiation of
dialysis.dialysis.
CONT…
7. 10/24/1610/24/16
Patho-physiologyPatho-physiology
• It has a complex pathophysiology.It has a complex pathophysiology.
• With unknown exact cause.With unknown exact cause.
• Endogenous guanidino compounds areEndogenous guanidino compounds are
neurotoxic.neurotoxic.
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Accumulating metabolites of proteins &
amino acids affect the entire neuraxis.
Several organic substances
accumulate
• Urea,
• Guanidine compounds,
• Uric acid,
• Hippuric acid,
• Various amino acids,
• Polypeptides,
• Polyamines,
• Phenols & conjugates of
phenols,
• Phenolic and indolic
acids,
• Acetoin,
• Glucuronic acid,
• Carnitine,
• Myoinositol,
• Sulfates,
• Phosphates, and middle
molecules.
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Accumulation of diamethylarginine
• It’s a NOS ( nitric oxide synthase)It’s a NOS ( nitric oxide synthase)
inhibitor.inhibitor.
• Observed in uremic Pts leads toObserved in uremic Pts leads to
vasoconstriction.vasoconstriction.
• Induces hypertension.Induces hypertension.
• Increases ischemia & vulnerability toIncreases ischemia & vulnerability to
uremic brain.uremic brain.
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• As uremia progressesAs uremia progresses
accumulation of guanidinoaccumulation of guanidino
compounds results incompounds results in
activation of excitatory N-methyl-D-activation of excitatory N-methyl-D-
aspartate (NMDA) receptors &aspartate (NMDA) receptors &
inhibition of inhibitory GABAinhibition of inhibitory GABA
receptors, which may causereceptors, which may cause
myoclonus & seizures..
• The encephalopathy correlates roughly
with BUN level, urea itself is not
thought to be causative.
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Abnormalities may beAbnormalities may be
associated with UEassociated with UE
• AcidosisAcidosis
• HyponatremiaHyponatremia
• HyperkalemiaHyperkalemia
• HypocalcaemiaHypocalcaemia
• HypermagnacemiaHypermagnacemia
• Over hydrationOver hydration
• Dehydration.Dehydration.
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FrequencyFrequency
• United StatesUnited States
• CrCl level < 10% of normal probablyCrCl level < 10% of normal probably
develop some degree of encephalopathy.develop some degree of encephalopathy.
• In one pediatric study, encephalopathyIn one pediatric study, encephalopathy
occurred in 40%, with a BUN level > 90occurred in 40%, with a BUN level > 90
mg/dL.mg/dL.
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Mortality/MorbidityMortality/Morbidity
• Symptoms include :-Symptoms include :-
•Somnolence & decreased mentation.Somnolence & decreased mentation.
•Asterixis usually present.Asterixis usually present.
•Symptoms are reversible followingSymptoms are reversible following
•Institution of dialysisInstitution of dialysis
•Renal transplantation .Renal transplantation .
16. •The severe complicationsThe severe complications
seizuresseizurescomacoma leads toleads to
death.death.
•Early recognition is crucial toEarly recognition is crucial to
prevent morbidity or mortality.prevent morbidity or mortality.
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CONT…
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ClinicalClinical
Symptoms begin insidiouslySymptoms begin insidiously
•Not noticed by patients but byNot noticed by patients but by
family members/caregivers.family members/caregivers.
•In many cases, CNS impairment
provides first indication of metabolic
derangements.
•Symptoms may progress slowly or
rapidly.
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Physical examPhysical exam
• Variable & depending on severity ofVariable & depending on severity of
encephalopathy.encephalopathy.
• Neurologic findings range fromNeurologic findings range from
normal to a comatose state.normal to a comatose state.
• Altered mental status (confusion)
• Cranial nerve signs (nystagmus)
• Papilledema
• Hyperreflexia, clonus, asterixis
• Stupor
• Coma occurs only if uremia
remains untreated & progresses.
22. 10/24/1610/24/16
CONT…..
•Myoclonic jerks, twitches, orMyoclonic jerks, twitches, or
fasciculationsfasciculations
•AsterixisAsterixis
•DysarthriaDysarthria
•AgitationAgitation
•TetanyTetany
•Seizures, usually generalized tonic-Seizures, usually generalized tonic-
clonicclonic
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Laboratory StudiesLaboratory Studies
11.. Electrolytes, BUN, creatinine, & glucoseElectrolytes, BUN, creatinine, & glucose
A-A- Markedly elevated BUN & creatinineMarkedly elevated BUN & creatinine
levels indicate UE.levels indicate UE.
B-B- Obtain serum electrolyte & glucoseObtain serum electrolyte & glucose
measurements to rule out other causes:-measurements to rule out other causes:-
-hyponatremia, -hypernatremia,-hyponatremia, -hypernatremia,
- hyperglycemia &- hyperglycemia &
-hyperosmolar syndromes-hyperosmolar syndromes
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2.2. Obtain CBC to detect leukocytosis,Obtain CBC to detect leukocytosis,
which may suggest an infectiouswhich may suggest an infectious
cause and determine whether anemiacause and determine whether anemia
is present.is present. (Anemia may contribute to the
severity of mental alterations.)
33.. Serum calcium, phosphate and PTHSerum calcium, phosphate and PTH
levels to determine the presence oflevels to determine the presence of
hypercalcaemia, hypophosphatemia,hypercalcaemia, hypophosphatemia,
and severe hyperparathyroidism,and severe hyperparathyroidism,
which cause metabolicwhich cause metabolic
encephalopathy.encephalopathy.
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Imaging StudiesImaging Studies
• Brain imaging is of limited valueBrain imaging is of limited value
•MRI or head CT with severe
neurologic symptoms to rule out
structural abnormalities (eg, CVA,
Intracranial mass).
•CT does not demonstrate any
characteristic findings for UE.
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Other TestsOther Tests
• Electroencephalogram:Electroencephalogram:
An EEG is commonly performed onAn EEG is commonly performed on
patients with metabolic encephalopathy.patients with metabolic encephalopathy.
Findings typically include the following:Findings typically include the following:
(1) slowing and loss of alpha(1) slowing and loss of alpha
frequency wavesfrequency waves
(2) disorganization(2) disorganization
(3) intermittent bursts of theta and(3) intermittent bursts of theta and
delta waves with slow backgrounddelta waves with slow background
activity.activity.
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Cognitive function testsCognitive function tests
Several cognitive function tests are used to evaluateSeveral cognitive function tests are used to evaluate
UE.UE.
• Uremia may result in worse performance onUremia may result in worse performance on
•The trail-making test:- which measures
psychomotor speed.
•The continuous memory test:- which
measures short-term recognition.
•The choice reaction time test:- which measures
simple decision making.
•Alterations in choice reaction time appear
to correlate best with renal failure.
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Histologic FindingsHistologic Findings
Brain histologic findings include:-
• Meningeal fibrosis
• Glial changes
• Edema
• Vascular degeneration
• Focal & diffuse neuronal degeneration
• Focal demyelination
• Small infarcts are also seen & are probably
due to HTN or focal necrosis
32. 10/24/1610/24/16
Medical CareMedical Care
• No medications are specific.No medications are specific.
• Care includes correcting metabolicCare includes correcting metabolic
disturbancedisturbance
•In ARF or CRF indication for early
initiation of :-
•Hemodialysis
•Peritoneal dialysis
•Continuous renal replacement
therapy.
33. After beginning dialysis, patient
generally improves clinically.
EEG findings may not improve
immediately.
•In ESRD, EEG improve after
several months but may not
completely normalize.
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CONT…
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Address the following factors:
1. Adequacy of dialysis
2. Correction of anemia
3. Regulation of calcium & phosphate
metabolism.
4. Medical parathyroidectomy.
5. Infections need to be treated
appropriately.
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SeizuresSeizures
May be treated with anticonvulsants.
• These drugs should be administered at
lower-than-usual doses.
• Low albumin levels can lead to higher
levels of unbound anticonvulsant.
• The unbound drug is therapeutically active
fraction.
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ConsultationsConsultations
1. Nephrologist
2. Vascular surgeon for placement of vascular access in
patients with ESRD.
3. Neurologist if symptoms do not improve upon
initiation of dialysis therapy.
4. Dietitian the one familiar with renal diseases.
5. Specialist in critical care medicine
6. Neurosurgeon Neurosurgical intervention for
intracranial hemorrhage or subdural hematoma.
7. Infectious disease specialist: Bacterial meningitis
remains a high cause of mortality in hemodialyzed
patients, often because of delay in treatment.
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•Patients need close follow-up in acute
stage of uremic encephalopathy.
•After underlying problem is treated
properly, the symptoms should
resolve.
•Levels of anticonvulsant drugs must
be closely monitored to prevent
toxicity.
40. CONT…CONT…
Further Outpatient Care:
•Schedule maintenance HD for ESRD.
•Carefully monitor mental status.
•Administer medications (eg, iron,
erythropoietin, phosphate binders,
vitamin D analogues) for patients
with ESRD to optimize their quality
of life.
•Avoid sedatives.
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42. PrognosisPrognosis
•The prognosis is generally favorable if
treatment is successful.
•With prompt dialytic therapy, the
mortality rate is low.
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43. Patient EducationPatient Education
10/24/1610/24/16
To ensure that treatment is initiated
early, instruct patients & their family
members & caregivers about the need
for prompt medical evaluation when
mental status changes occur.