CDN Complications and Emergency Management 1 — Questions and Answers
Question 1: What is the most common acute complication during hemodialysis?
- Air embolism
- Hypotension (Correct answer)
- Dialyzer reaction
- Hyperkalemia
Correct answer: Hypotension
Intradialytic hypotension (IDH) is the most common acute complication of hemodialysis, occurring in approximately 20–30% of treatments due to rapid fluid removal and autonomic dysfunction.
Question 2: A dialysis patient suddenly develops chest pain, dyspnea, cyanosis, and frothy pink sputum during treatment. What complication should be suspected?
- Dialyzer clotting
- Acute pulmonary edema (Correct answer)
- Air embolism
- Dialysis disequilibrium syndrome
Correct answer: Acute pulmonary edema
Frothy pink sputum, dyspnea, and cyanosis during dialysis indicate acute pulmonary edema, which may occur if ultrafiltration is insufficient or if the patient develops a cardiac event.
Question 3: What is the immediate treatment for intradialytic hypotension?
- Administer sublingual nitroglycerin
- Place the patient in Trendelenburg position, reduce or stop ultrafiltration, and give a normal saline bolus (Correct answer)
- Increase the blood pump speed
- Stop dialysis and transfer to the emergency department
Correct answer: Place the patient in Trendelenburg position, reduce or stop ultrafiltration, and give a normal saline bolus
Immediate management of IDH includes Trendelenburg positioning, stopping or reducing ultrafiltration, and administering a normal saline bolus of 100–250 mL to restore intravascular volume.
Question 4: Which electrolyte abnormality is the most common cause of cardiac arrest in hemodialysis patients between treatments?
- Hyponatremia
- Hypocalcemia
- Hyperkalemia (Correct answer)
- Hyperphosphatemia
Correct answer: Hyperkalemia
Hyperkalemia is the leading electrolyte cause of between-treatment cardiac arrest in hemodialysis patients, as potassium accumulates rapidly without renal excretion.
Question 5: Dialysis disequilibrium syndrome (DDS) is most likely to occur in which clinical scenario?
- Experienced patient undergoing routine treatment
- New patient receiving first aggressive hemodialysis treatment with high BUN (Correct answer)
- Patient with well-controlled uremia receiving maintenance dialysis
- Patient receiving slow continuous renal replacement therapy
Correct answer: New patient receiving first aggressive hemodialysis treatment with high BUN
DDS occurs when rapid urea removal creates an osmotic gradient that draws water into brain cells, most commonly in new patients with very high BUN receiving their first aggressive dialysis.
Question 6: What is the emergency treatment for suspected air embolism during hemodialysis?
- Administer heparin IV and continue dialysis
- Immediately clamp venous line, stop blood pump, place patient in left lateral Trendelenburg position, and call for emergency help (Correct answer)
- Increase blood flow to flush air through system quickly
- Administer oxygen and reduce ultrafiltration rate
Correct answer: Immediately clamp venous line, stop blood pump, place patient in left lateral Trendelenburg position, and call for emergency help
Air embolism requires immediate cessation of blood flow, left lateral Trendelenburg positioning (to trap air in right ventricle away from pulmonary circulation), and emergency medical support.
CDN Complications and Emergency Management 1
What is the most common acute complication during hemodialysis?