CDN Fluid and Electrolyte Balance in Dialysis 2 — Questions and Answers
Question 1: Which acid-base disorder is most commonly observed in patients with end-stage renal disease prior to dialysis?
- Metabolic alkalosis
- Respiratory acidosis
- Metabolic acidosis (Correct answer)
- Respiratory alkalosis
Correct answer: Metabolic acidosis
Failed kidneys cannot excrete fixed acids or regenerate bicarbonate, leading to chronic metabolic acidosis in ESRD patients.
Question 2: What interdialytic weight gain is generally considered the maximum acceptable limit for a hemodialysis patient?
- 1 kg
- 2 kg
- 3–5% of dry body weight (Correct answer)
- 8–10% of dry body weight
Correct answer: 3–5% of dry body weight
Interdialytic weight gain up to 3–5% of dry body weight is generally considered acceptable, though lower gains are associated with better outcomes.
Question 3: Which sign/symptom is associated with hyponatremia in a dialysis patient?
- Dry mucous membranes and thirst
- Confusion, seizures, and muscle weakness (Correct answer)
- Hypertension and bradycardia
- Periorbital edema only
Correct answer: Confusion, seizures, and muscle weakness
Severe or rapidly developing hyponatremia causes neurological symptoms including confusion, seizures, and weakness due to cerebral edema.
Question 4: A dialysis patient develops peaked T-waves and widened QRS on ECG. Which electrolyte abnormality is most likely responsible?
- Hypokalemia
- Hypocalcemia
- Hyperkalemia (Correct answer)
- Hypermagnesemia
Correct answer: Hyperkalemia
Hyperkalemia produces sequential ECG changes including peaked T-waves, PR prolongation, widened QRS, and ultimately sine-wave pattern with cardiac arrest.
Question 5: What role does aluminum toxicity play in dialysis patients?
- Causes hyperkalemia
- Leads to adynamic bone disease and encephalopathy (Correct answer)
- Causes hyperphosphatemia
- Increases erythropoietin resistance by raising hemoglobin
Correct answer: Leads to adynamic bone disease and encephalopathy
Aluminum accumulation in dialysis patients, historically from aluminum-containing phosphate binders and contaminated water, causes adynamic bone disease, anemia, and encephalopathy.
Question 6: Which dietary restriction is most important for ESRD patients between hemodialysis sessions to prevent life-threatening complications?
- Limit protein to 20 g/day
- Restrict potassium and phosphorus intake (Correct answer)
- Avoid all sodium
- Restrict dietary fat
Correct answer: Restrict potassium and phosphorus intake
Limiting potassium prevents fatal hyperkalemia and limiting phosphorus prevents secondary hyperparathyroidism and vascular calcification between dialysis sessions.
CDN Fluid and Electrolyte Balance in Dialysis 2
Which acid-base disorder is most commonly observed in patients with end-stage renal disease prior to dialysis?