CDN Dialysis Complications and Emergency Management 2 — Questions and Answers
Question 1: What is the most common cause of intradialytic hypotension?
- Dialysate sodium that is too low
- Ultrafiltration rate exceeding plasma refilling rate (Correct answer)
- High dialysate temperature
- Dialyzer membrane incompatibility
Correct answer: Ultrafiltration rate exceeding plasma refilling rate
Intradialytic hypotension most commonly occurs when the ultrafiltration rate exceeds the body's ability to refill the intravascular space from interstitial fluid.
Question 2: Which electrolyte imbalance is most likely to cause life-threatening cardiac arrhythmias in a dialysis patient?
- Hyponatremia
- Hyperphosphatemia
- Hyperkalemia (Correct answer)
- Hypercalcemia
Correct answer: Hyperkalemia
Hyperkalemia is the most immediately life-threatening electrolyte abnormality in dialysis patients, capable of causing fatal ventricular arrhythmias.
Question 3: A patient develops fever and shaking chills approximately 45 minutes into hemodialysis. What is the most likely cause?
- Type A hypersensitivity reaction
- Pyrogenic reaction from contaminated dialysate or equipment (Correct answer)
- Dialysis disequilibrium syndrome
- Hemolysis due to overheated dialysate
Correct answer: Pyrogenic reaction from contaminated dialysate or equipment
Pyrogenic reactions are caused by bacterial endotoxins in dialysate or equipment, triggering an immune response with fever and rigors.
Question 4: When treating intradialytic hypotension, which intervention should be performed first?
- Administer 0.9% normal saline bolus
- Place patient in Trendelenburg position and reduce ultrafiltration (Correct answer)
- Increase dialysate sodium concentration
- Administer midodrine
Correct answer: Place patient in Trendelenburg position and reduce ultrafiltration
Placing the patient flat or in Trendelenburg and reducing or stopping ultrafiltration is the immediate first response to intradialytic hypotension.
Question 5: Which dialysis complication is specifically associated with inadequate bicarbonate delivery in the dialysate?
- Muscle cramps
- Metabolic acidosis (Correct answer)
- Dialyzer membrane rupture
- Hypercalcemia
Correct answer: Metabolic acidosis
Inadequate bicarbonate in dialysate fails to correct the chronic metabolic acidosis that accumulates between hemodialysis sessions.
Question 6: A patient reports painful leg and foot cramps during the last hour of hemodialysis. What is the most appropriate initial intervention?
- Administer IV calcium gluconate
- Reduce blood flow rate and administer hypertonic saline or glucose (Correct answer)
- Discontinue dialysis immediately
- Increase ultrafiltration rate to clear cramp-causing toxins
Correct answer: Reduce blood flow rate and administer hypertonic saline or glucose
Dialysis-related muscle cramps are treated by reducing ultrafiltration rate and administering hypertonic saline or glucose to rapidly expand intravascular volume.
CDN Dialysis Complications and Emergency Management 2
What is the most common cause of intradialytic hypotension?