Dialysis Disequilibrium

The abrupt onset of neurologic symptoms following hemodialysis has been attributed to cerebral edema. Although much speculation focuses on differential fluid shifts related to a rapid decrease in blood urea nitrogen, the specific cause of this osmotic edema remains controversial. A reverse urea effect theorizes that the BBB prevents urea concentrations in the brain from decreasing with serum levels during and immediately following dialysis. A relative hyperosmolar state within the brain encourages the formation of osmotic edema. This fluid shift depends on the rate of dialysis and may be reversed by increasing serum osmolarity. The reverse urea effect hypothesis has been disputed and recent attention has focused on the role of idiogenic osmoles, which has been suggested because urea levels do not fully explain changes in CSF and serum osmolarity measurements. The generation of these organic acids as a protective mechanism against dehydration has been speculated to account for postdialysis decreases in intracellular pH. The clinical manifestations are usually transient and may be avoided or minimized by employing slower rates of solute removal, increasing plasma osmolarity with mannitol, or modifying dialysis solutions.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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