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Hypoglycemia:
• Hypoglycemia is a rare dialysis complication, because many
dialysate solutions contain glucose at a concentration equal to
the blood glucose level, and even in absence of glucose in
dialysate, neurological complications linked to moderate
hypoglycemia can usually be avoided if short sessions are
used and if a snack is given to patients during or after the
session.
Hypercalcemia:
• Hypercalcemia has been reported in HD patients receiving
dialysis with inappropriately high dialysis fluid calcium
concentrations and/or large doses of vitamin D and/or
calcium-based chelating agents.
• Whatever the cause, these patients show evidence of a severe
encephalopathy, ranging from impaired intellectual
functioning to delirium, stupor, and coma. The handling
includes hemo- or peritoneal dialysis with calcium-free
solutions.
Malnutrition
• Folate, water-soluble vitamins, and vitamin C are removed
during dialysis. Folate deficiency, leading to axonal
degeneration, demyelination, and neuronal death, and
thiamine (B1) and B12 deficiencies may all induce the classical
signs of metabolic encephalopathies.
• These deficiencies may be associated with high homocysteine
blood levels, which carry an elevated risk for atherosclerosis.
• In some patients plasma homocysteine levels may be normal:
due to supplementation of folic acid and water-soluble
vitamins.
• Low-dose megestrol (20 mg orally, twice daily) may increase
serum albumin levels of malnourished HD patients.
Role of Erythropoietin
Groups
• Infants-childhood:
– Uremic toxins on immature brain
– Al-independent
• Adult sporadic-endemic:
– Worldwide distribution,
– Al-independent,
– No therapy
• Adult epidemic:
– Geography dependent,
– Al dependent (Al in dialysis water)
– Epidemic,
– Trace elements in water
Differential diagnosis
Possible causes