Dialysis Unit Communication: Real Time or Real Problem

Dialysis Unit Communication: At present, there are more than 6500 dialysis centers in the United States that provide life-saving care for patients with end-stage renal disease (ESRD) requiring renal replacement therapy.  This often thrice-weekly form of treatment has become commonplace in virtually every major city and suburb in the US.  Dialysis care is almost universally provided by Nephrologists (physicians specializing in the diagnosis and treatment of kidney diseases) in close collaboration with a team of health care providers that includes specially trained dialysis nurses technicians, social workers, and dieticians.  Dialysis care is now considered sufficiently routine that the Nephrologists need not be present during each treatment.

Potential Consequences of Dialysis: As with any procedure, hemodialysis carrels a small but significant risk of complication including infection, low blood pressure, and bleeding.  The risk of choric blood loss is real, even under ideal conditions; however, blood loss may also be acute, especially in patients with plastic dialysis catheters that are susceptible to accidental disconnection during or after the dialysis procedure.

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Mild Hyponatremia: New Risk of Memory Changes, Gait Disturbances and Death

Hyponatremia is defined as a lower than normal serum sodium concentration using routine laboratory testing of serum electrolytes.  Although chronic hyponatremia below 120 mEq almost universally prompts medical investigation, milder forms are usually overlooked or disregarded as being of little clinical significance. Recently, mild-moderate hyponatremia (i.e., a serum sodium concentration >125-135 mEq/L) has been associated with distinct symptoms as well as with increased mortality after hospitalization.

What causes hyponatremia? Many conditions are associated with chronic hyponatremia, the single most common electrolyte abnormality.  These include inflammation in the brain or lung, cancers, thyroid disease, kidney disease, heart failure, and several categories of medications such as oral hypoglycemics (used in patients with diabetes mellitus), narcotics, diuretics, and antidepressants, particularly those agents referred to as selective serotonin receptor inhibitors (SSRI agents).

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