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    Uremic Encephalopathy

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    stephanie hutasoit19
    Uremic encephalopathy is an organic brain disorder that results from the accumulation of toxins normally cleared by the kidneys due to renal failure. Symptoms range from mild fatigue and lassitude to severe seizures and coma, and depend on the rate of decline in renal function. While the exact cause is unknown, it is thought that the buildup of guanidino compounds and nitric oxide synthase inhibitors leads to neurotoxicity and vasoconstriction in the brain. Treatment focuses on fluid balance, electrolyte correction, and initiating dialysis to remove toxins if symptoms are severe or progressive.

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    Uremic Encephalopathy

    Uploaded by

    stephanie hutasoit19
    28 views30 pages
    Uremic encephalopathy is an organic brain disorder that results from the accumulation of toxins normally cleared by the kidneys due to renal failure. Symptoms range from mild fatigue and lassitude to severe seizures and coma, and depend on the rate of decline in renal function. While the exact cause is unknown, it is thought that the buildup of guanidino compounds and nitric oxide synthase inhibitors leads to neurotoxicity and vasoconstriction in the brain. Treatment focuses on fluid balance, electrolyte correction, and initiating dialysis to remove toxins if symptoms are severe or progressive.

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    Uremic encephalopathy is an organic brain disorder that results from the accumulation of toxins normally cleared by the kidneys due to renal failure. Symptoms range from mild fatigue and lassitude to severe seizures and coma, and depend on the rate of decline in renal function. While the exact cause is unknown, it is thought that the buildup of guanidino compounds and nitric oxide synthase inhibitors leads to neurotoxicity and vasoconstriction in the brain. Treatment focuses on fluid balance, electrolyte correction, and initiating dialysis to remove toxins if symptoms are severe or progressive.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    28 views30 pages

    Uremic Encephalopathy

    Uploaded by

    stephanie hutasoit19
    Uremic encephalopathy is an organic brain disorder that results from the accumulation of toxins normally cleared by the kidneys due to renal failure. Symptoms range from mild fatigue and lassitude to severe seizures and coma, and depend on the rate of decline in renal function. While the exact cause is unknown, it is thought that the buildup of guanidino compounds and nitric oxide synthase inhibitors leads to neurotoxicity and vasoconstriction in the brain. Treatment focuses on fluid balance, electrolyte correction, and initiating dialysis to remove toxins if symptoms are severe or progressive.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 30

    Uremic

    Encephalopathy
    Introductioin
    • Uremic Encephalop athy is an organic brain
    disorder.

    • Uremia is final stage of pro gressive renal


    insufficiency & resultant mul tiorgan failure.

    • It results from accumulati ng metabolites of


    proteins & amino acids

    10/24/16
    CONT…

    • No single metabolite has b een


    identified as the sole cause of uremia.

    • Uremic encephalopathy (UE) is one of


    many manifestations of renal failure
    (RF).

    10/24/16
    CONT..

    • Occurs due to build up of toxins which


    are normally cleared by k idneys.
    • It develops in pts with RF, usually
    when creatinine clearance levels fall &
    remain below 15 mL/m in.
    • Manifestations vary fro m
    Mild symptoms (eg, lassitude,
    fatigue) to
    Severe symptoms (eg, seizures,coma).

    10/24/16
    CONT…

    • Severity & progression de pend on rate


    of decline in renal functio n.
    Symptoms are usually worse in ARF.
    • Prompt identification of uremia as the
    cause of encephalopath y is essential
    because symptoms are r eadily
    reversible following initiation of
    dialysis.

    10/24/16
    Patho-physiology

    • It has a complex pathophy siology.


    • With unknown exact caus e.
    • Endogenous guanidino co mpounds are
    neurotoxic.

    10/24/16
    Accumulation of diamethylarginine

    • It’s a NOS ( nitric oxide sy nthase)


    inhibitor.
    • Observed in uremic Pts le ads to
    vasoconstriction.
    • Induces hypertension.
    • Increases ischemia & v ulnerability to
    uremic brain.

    10/24/16
    • As uremia progress es
    accumulation o f guanidino
    compounds results in
    activation of excitatory N-methyl-D-
    aspartate (NMDA) recep tors &
    inhibition of inhibitory GABA
    receptors, which may cause
    myoclonus & seizures .
    •

    10/24/16
    Abnormalities may be
    associated with UE
    • Acidosis
    • Hyponatremia
    • Hyperkalemia
    • Hypocalcaemia
    • Hypermagnacemia
    • Over hydration
    • Dehydration.

    10/24/16
    Mortality/Morbidity
    • Symptoms include :-
    Somnolence & decrease d mentation.
    Asterixis usually presen t.
    Symptoms are reversi ble following
    • Institution of dialy sis
    • Renal transplantat ion .

    10/24/16
    CONT…

    The severe complicati ons


    seizurescoma l eads to
    death.
    Early recognition is crucial to
    prevent morbidity or mortality.

    10/24/16
    Changes in
    sensorium • Patients may
    include:- complain of:
    • Loss of memory
    • Slurred speech
    • Impaired
    concentration • Pruritus
    • Depression • Muscle twitches
    • Delusions
    • Restless legs.
    • Lethargy
    • Irritability
    • Fatigue
    • Insomnia
    • Psychosis
    • Stupor
    • Catatonia &
    • Coma.
    10/24/16
    Laboratory Studies

    1 . Electrolytes, BUN, creatinine, & glucose


    A- Markedly elevated BUN & creatinine
    levels indicate UE.
    B- Obtain serum electrolyte & glucose
    measurements to rule out other causes:-
    -hyponatremia, -hypernat remia,
    - hyperglycemia &
    -hyperosmolar syndr omes

    10/24/16
    2. Obtain CBC to d et ect leukoc ytosis,
    which may sugges t an inf ectious
    cause and determine wh ether anemia
    is present.

    3 . Serum calcium, phosp hate and PTH


    levels to determine th e presence of
    hypercalcaemia, hypo phosphatemia,
    and severe hyperpa rathyroidism,
    which cause metab olic
    encephalopathy.
    10/24/16
    Other Tests

    • Electroencephalogram:
    An EEG is commonly pe rformed on
    patients with metabolic ence phalopathy.
    Findings typically includ e the following:
    (1) slowing and loss of alpha
    frequency waves
    (2) disorganization
    (3) intermittent bursts of theta and
    delta waves with slow background
    10/24/16
    activity.
    • Bedakan GGA prerenal, renal, postrenal
    • Underlying disease ?
    • GGK ?

    • Tanda vital
    • derajat dehidrasi
    • pemeriksaan abdomen
    • pemeriksaan neurologis
    • tanda-tanda penyakit dasar
    PENATALAKSANAAN

    1. Keseimbangan cairan, pengaturan kalori


    2. Koreksi:
    Asidosi Hipertensi
    Hiponatremia
    s

    Hiperkalemia
    Hipocalcemia Anemia

    3. Pengobatan penyakit primer


    Pengobatan pada fase oliguri

    a. Memperbaiki Diuresis

    Sesuai kebutuhan
    Garam isotonik/RL 20-30 cc/kg BB: 1 jam
     Diuresis belum ada
    Furosemid 1-2 mg/KgBB
    Atau: Monitol 20% : 0,5 gr/KgBB (iv) : 2 jam
    b. Mengatur Cairan dan Kalori
    • Intake cairan/hari = 25 ml/100 kal + jumlah urine output
    Jenis : glukose 10-30%
    • Kebutuhan kalori:

    3-10 kg 11-20 kg > 20 kg

    100 kal/kgBB 1000 kal + 50 1500 kal + 20


    kal/KgBB diatas 10 kal/KgBB diatas
    kg 20 kg
    Kadar K: 5,5-7 mEq/L c. Hiperkalemia

    Diberikan Kayeksalat 1 gr/KgBB


    • Oral: dilarutkan dlm 2ml/KgBB Sorbitol 70%
    • Enema : dilarutkan dalam 10ml/KgBB Sorbitol 20%
    Kadar K> 7 • Dapat diulang 2-6 jam sampai kadar K normal
    mEq/L

    Cara diatas +
    • Ca glukonat 10% 0,5 ml/KgBB iv pelan-pelan (10 menit)
    • Na Bicabonat 7,5% : 3 mEq/KgBB
    • Glukosa 50% 1 ml/kgBB + 1 unit RI untuk tiap 5 gr glukosa
    iv selama 1 jam
    • Salbutamol iv 4-5 mikrog/kg slm 10-15 menit atau dgn
    nebulisasi ( 2,5 mg untukBB < 25 kg ; 5 mg untuk BB > 25
    kg ).
    d. Asidosis

    Na bikarbonat 7,5% sebanyak 0,3 x BB(kg) x [12-serum HCO 3-]

    e. Hipokalsemia

    Pemberian Kalsium glukonas 10% 0,1mmol/kg/hari (0,5


    ml/kg/hari) secara titrasi
    f. Hiponatremi

    Bila Na < 120mEq/L diberikan Nacl 3% sebanyak:


    0,6 x BB (Kg) x [125-Serum Na] mEq

    g. Anemia
    Hb < 7 gr% atau ada tanda-tanda gangguan hemodinamik diberi
    transfusi.
    HIPERTENSI KRISIS - ENSEFALOPATI
    H. Ensefalopati

    Gangguan fungsi otak akut dan sementara akibat meninggian


    tekanan darah. Sakit kepala  hebat/muntah
    Gejala 2
    1
    3
    Kejang
    Afasia, hemifaresis, KK
    H. Krisis

    Sistolik < 180 mmHg

    2
    1

    3
    Diastolik > 120 mmHg

    Hipertensi dengan komplikasi (dekom,


    edema papil, ensefalopati)
    DIALISIS
    Indikasi:
    Hipervolemik berat
    (dekom cordis oedem Asidosis berat
    paru) ( HCO3- < 10mEq/l)

    BUN > 150 mg%


    Uremia dengan
    disorientasi, kejang, stupor

    K> 8 mEq/L
    Pilihan Dialysis
    • Ketika belum ada pilihan transplantasi maka:

    rntklm rntg &E
    • Pilihan bergantung kepada umur pasien, teknik,
    sosial, kepatuhan dan keinginan keluarga

    s lmiy
    51`?
    Perbandingan DP dan HD
    PERITONEAL DIALISIS HEMODIALISIS
    Secara tehnik lebih mudah Pemindahan metabolit dapat
    dikerjakan meliputi molekul yang lebih kecil
    Menghindari pemindahan cairan, Hanya tersedia di beberapa
    elektrolit dan metabolit lain secara fasilitas pelayanan kesehatan
    mendadak Membutuhkan pengaturan
    Meminimalisasi restriksi restriksi cairan
    kebutuhan cairan dan dietetik Dapat dilakukan 3x/minggu
    Membutuhkan tanggunjg jawab dengan lama hemodialisis 3-5 jam
    yang lebih dari orang tua/pengasuh tergantung kebutuhan
    Mengurangi komplikasi anemia,
    mengontrol hipertensi lebih baik
    Dapat membosankan karena
    menjadi rutinitas harian
    Terima Kasih

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