SEIZURES

Uncommon Hemodialysis Complication

Mark Francis M. Concepcion, RN

Seizure
Seizures are not uncommon in dialysis patients. Generalized seizures are an integral feature of advanced uremic encephalopathy. Seizures can also be a manifestation of severe disequilibrium syndrome, as discussed aboveIntracranial hemorrhage commonly leads to focal seizures, while most of the other causes lead to generalized seizures.

Mark Francis M. Concepcion, RN

Etiologies and Related Conditions

Uremic encephalopathy Disequilibrium syndrome Drugs, such as erythropoietin, carbapenem and ertapenem Cerebrovascular disease, such as infarction, hemorrhage, and subdural hematoma Aluminum encephalopathy Hypertensive encephalopathy Intracranial hemorrahage Alcohol withdrawal
Mark Francis M. Concepcion, RN 3

Etiologies and Related Conditions

Toxins (star fruit ingestion) Others (Metabolic): Hypocalcemia Hypoglycemia and hyperglycemia Hyperosmolality due to peritoneal dialysis Hypernatremia (accidental due to hemodialysis malfunction) or hyponatremia

Mark Francis M. Concepcion, RN

Etiologies and Related Conditions

Anoxia Arryhthmia Anaphylaxis Severe hypotension Air embolism

Mark Francis M. Concepcion, RN

Prevention
Identification of susceptible subgroups Predialysis serum urea nitrogen (BUN) >130 mg/dl Severe hypertension Children Patients receiving erythropoietin (EPO) Previous seizure disorder Predialysis hypocalcemia (<6mg/dl) with acidosis Limiting initial dialysis session length and BFR
Mark Francis M. Concepcion, RN 6

Prevention
Use of 3.5 meq/L or 4.0 meq/L calcium bath in hypocalcemic patients; administration of IV calcium during dialysis if necessary Meticulous attention to blood pressure control during EPO therapy Limiting exposure to ethanol and to epileptogenic drugs: Penicillin
Mark Francis M. Concepcion, RN

Fluoroquinolones Cyclosporine Meperidine Theophylline Metoclopramide Lithium

Treatment and Management

Stopping dialysis Maintenance of patent airway Institute seizure precautions Padded siderails Avoid a stimulating environment (ex. Dim lighting) Suction machine at bedside Never moving or restraining the patient when there is active seizure

Mark Francis M. Concepcion, RN

Treatment and Management

Drawing blood for glucose, calcium and serum electrolytes If hypoglycemia is suspected, IV glucose can be given Administration of IV diazepam, lorazepam or phenytoin if required Treat the metabolic disturbance if present

Mark Francis M. Concepcion, RN