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Unexpected seizures during hemodialysis

Effect of dialysate prescription

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Abstract

To assess the effects of the dialysate prescription on the intradialytic neurological stability of children requiring chronic hemodialysis (HD), continuous EEG monitoring (CEM) was performed on five children before, during and after HD against: (1) low sodium acetate (LAc: Na 132 mEq/l, acetate 38 mEq/l); (2) high sodium acetate (HAc: Na 144 mEq/l, acetate 41 mEq/l), and (3) low sodium bicarbonate (LBi: Na 133 mEq/l, bicarbonate 35 mEq/l) dialysate. Three children, two with clinically well-controlled seizure disorders and one with no seizure history, exhibited subclinical seizures on LAc and HAc but improved neurological stability on LBi. Two children had essentially unchanged CEM studies on any HD regimen. Symptoms of disequilibrium were noted in four of the five children on LAc, two of the five on HAc and only one of the five on LBi. The data suggest that bicarbonate HD may enhance intradialytic neurological stability, particularly in children with known seizure disorders. Furthermore, CEM was found to be a useful tool for evaluating the neurological stability of children during HD.

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References

  1. Polinsky MS (1984) Neurologic complications of ESRD, dialysis and transplantation. In: Fine RN, Gruskin AB (eds) End stage renal disease in children. Saunders, Philadelphia, pp 307–339

    Google Scholar 

  2. Guisado RG, Arieff AI, Massry SG (1975) Changes in the electroencephalogram in acute uremia: effects of parathyroid hormone in brain electrolytes. J Clin Invest 55: 738–745

    PubMed  Google Scholar 

  3. Cooper JD, Lazarowitz BC, Arieff AI (1978) Neurodiagnostic abnormalities in patients with acute renal failure: evidence for neurotoxicity of parathyroid hormone. J Clin Invest 61:1445–1448

    Google Scholar 

  4. Rivera-Vazquez AB, Noriega-Sanchez A, Ramirez-Gonzalez R, Martinez-Maldonado M (1980) Acute hypercalcemia in hemodialysis patients: distinction from “dialysis dementia”. Nephron 25:243–246

    PubMed  Google Scholar 

  5. Alfrey AC (1984) Aluminium intoxication. N Engl J Med 310:1113–1115

    PubMed  Google Scholar 

  6. Schnaper HW, Cole BR, Hodges FJ, Robson AM (1983) Cerebral cortical atrophy in pediatric patients with end stage renal disease. Am J Kidney Dis 2:645–650

    PubMed  Google Scholar 

  7. Rotundo A, Nevins TE, Lipton M, Lockman LA, Mauer SM, Michael AF (1982) Progressive encephalopathy in children with chronic renal insufficiency in infancy. Kidney Int 21:486–491

    PubMed  Google Scholar 

  8. Kjellstrand CM (1980) Osmolar changes during dialysis. Int J Artif Organs 3:251–253

    PubMed  Google Scholar 

  9. Arieff AI, Massry SG, Barrientos A, Kleeman CR (1973) Brain water and electrolyte metabolism in uremia: effects of slow and rapid hemodialysis. Kidney Int 4:177–187

    PubMed  Google Scholar 

  10. Rosa AA, Schideman J, McHugh R, Duncan D, Kjellstrand CM (1981) The importance of osmolality fall and ultrafiltration rate on hemodialysis side effects, influence of intravenous mannitol. Nephron 27:134–141

    PubMed  Google Scholar 

  11. Port FK, Johnson WJ, Klass DW (1973) Prevention of dialysis disequilibrium syndrome by the use of high sodium concentration in the dialysate. Kidney Int 3:327–333

    PubMed  Google Scholar 

  12. Kampl H, Klopp H, Wolfgruber M, Pustelnik A, Schiller R, Hanefeld F, Kessel M (1982) Advantages of bicarbonate hemodialysis. Artif Organs 6:410–416

    PubMed  Google Scholar 

  13. Kiley JE, Pratt KL, Gissen DG, Schaffer CA (1976) Techniques of EEG frequency analysis for evaluation of uremic encephalopathy. Clin Nephrol 5:245–250

    PubMed  Google Scholar 

  14. Polinsky MS, Baired HW, Gruskin AB (1981) Evaluation of neurologic dysfunction in children with chronic renal failure by neurometrics. Pediatr Res 15:698A

    Google Scholar 

  15. Kiley JE, Hines O (1965) Electroencephalographic evaluation of uremia. Arch Intern Med 116:67–73

    PubMed  Google Scholar 

  16. Teschan PE (1975) Electroencephalographic and other neurophysiologic abnormalities in uremia. Kidney Int 7: S210-S216

    Google Scholar 

  17. Hampers CL, Doak PB, Callaghan MN, Tyler HR, Merrill JP (1966) Electroencephalogram and spinal fluid during hemodialysis. Arch Intern Med 118:340–346

    PubMed  Google Scholar 

  18. Hakim RM, Pontzer MA, Titlton D, Lazarus JM, Gottlieb MN (1985) Effects of acetate and bicarbonate dialysate in stable, chronic dialysis patients. Kidney Int 28:535–540

    PubMed  Google Scholar 

  19. Blanchet F, Kanfer A, Cramer E, Benyahia A, Georges R, Mery JP, Amiel C (1984) Relative contribution of intrinsic lung dysfunction and hypoventilation to hypoxemia during hemodialysis. Kidney Int 26:430–435

    PubMed  Google Scholar 

  20. Mastrangelo F, Rizzelli S, Corliano C, Montinaro AM, DeBlasi V, Alfonso L, Aprile M, Napoli M, Rosalia L (1985) Benefits of bicarbonate dialysis. Kidney Int 28: S188-S193

    Google Scholar 

  21. Ruder MA, Alpert MA, Van Stone J, Selmon MR, Kelly DL, Haynie JD, Perkins SK (1985) Comparative effects of acetate and bicarbonate hemodialysis on left ventricular function. Kidney Int 27:768–773

    PubMed  Google Scholar 

  22. Cybulsky AVE, Matini A, Hollomby DJ (1985) Effects of high sodium dialysate during maintenance hemodialysis. Nephron 41:57–61

    PubMed  Google Scholar 

  23. Wilkinson R, Barber SG, Robson V (1977) Cramps, thirst and hypertension in hemodialysis patients — the influence of dialysate sodium concentration. Clin Nephrol 7: 101–105

    PubMed  Google Scholar 

  24. Hsu CH, Swartz RD, Somermeyer MG, Raj A (1984) Bicarbonate hemodialysis: influence on plasma refilling and hemodynamic stability. Nephron 38:202–208

    PubMed  Google Scholar 

  25. Donckerwolcke RA, Chantler C, Broyer MJC (1983) Paediatric dialysis. In: Drukker W, Parsons RM, Maher JF (eds) Replacement of renal function by dialysis. Martinus Nijhoff, Boston, pp 514–535

    Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, University of Colorado Medical School, 4200 E. Ninth Avenue, Box C282, 80262, Denver, CO, USA

    Douglas M. Ford & Gary M. Lum

  2. Fitzsimons Army Medical Center, Denver, Colorado, USA

    Ronald J. Portman & Daniel L. Hurst

Authors
  1. Douglas M. Ford
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  2. Ronald J. Portman
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  3. Daniel L. Hurst
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  4. Gary M. Lum
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Ford, D.M., Portman, R.J., Hurst, D.L. et al. Unexpected seizures during hemodialysis. Pediatr Nephrol 1, 597–601 (1987). https://doi.org/10.1007/BF00853594

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  • DOI: https://doi.org/10.1007/BF00853594

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