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Acute Encephalopathy Occurring During HemodialysisThe Reverse Urea Effect
HART deC. PETERSON, MD;
AUGUST G. SWANSON, MD
Arch Intern Med. 1964;113(6):877-880.
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Although hemodialysis is generally safe and effective in treating acute renal failure, symptoms of headache, agitation, and confusion occasionally develop.1 We have recently observed three patients who developed a severe encephalopathy during hemodialysis. In all three cases neurological deterioration coincided with rapid reduction of blood urea, and we postulate that the blood-brain barrier prevented a parallel and equally rapid reduction of brain urea. This produced an osmotic differential between brain and blood causing movement of water into brain with resultant water intoxication and brain swelling.
Report of Cases
CASE 1.
—A 14-year-old boy (UWH 151-157) with a three-year history of chronic renal failure was referred to the University of Washington Hospital for hemodialysis.
On admission he appeared chronically ill. Funduscopic examination revealed arteriovenous nicking, tortuous vessels, and arteriolar narrowing. He had a rachitic rosary, and his heart was enlarged to percussion. His blood pressure was 150/110 mm Hg, and
. . . [Full Text PDF of this Article]
Author Affiliations
SEATTLE
Special Fellow, US Public Health Service BT-836, present address: Department of Neurology, New York Hospital, 525 E 68th St, New York (Dr. Peterson); Associate Professor of Neurology and Pediatrics, Cornell University Medical College, New York (Dr. Swanson).
From the Division of Neurology, University of Washington School of Medicine.
Footnotes
Received for publication Nov 14, 1963; accepted Dec 20.
Read before the annual meeting of the American Academy of Neurology, Minneapolis, April 26, 1963.
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