Prefinal osce and learning objectives

  Blog link :-

https://nikithapalnati102.blogspot.com/2023/12/60-y-old-male-patient-with-ckd-on-mhd.html?m=1

Learning points

1. learnt how to perform joint proprioception test properly
2. Learnt another way of assessing vibration sense (time duration).
3. Learnt the importance of daily routine for identifying the onset of disesase properly.
4. Learnt how to assess complete cns examination 
5. Learnt about indications and complications of dialysis 

Osce

Ques:-  Causes of quadriparesis?

             Can be due to  Infections,toxins,drugs

               .medical conditions like guillianbarre syndrome,  DKA,electrolyte disturbances 

                . Injury or trauma to spine 

   In this patient can it be due to history of fall?ekectrolyte imbalance?

Ques:- dialysis disequilibrium syndrome

           

Dialysis disequilibrium syndrome (DDS) refers to an array of neurological manifestations seen during or following dialysis, primarily after the new initiation of dialysis.However, it can also be seen in chronic dialysis patients who miss their regular dialysis treatments. This syndrome is thought to arise from fluid shifts during hemodialysis, causing cerebral edema and a wide variety of neurological symptoms. In continuous renal replacement therapies (CRRT), where fluid shift is limited, dialysis disequilibrium syndrome is rarely reported.

The common risk factors that predispose a patient to dialysis dysequilibrium syndrome are 

• First hemodialysis treatment
• High blood urea nitrogen (BUN) (above 175 mg/dL or 60 mmol/L) before initiation of dialysis
• Extremes of age – children and elderly
• Sudden change in dialysis regimen
• Pre-existing neurological diseases such as stroke, malignant hypertension, head trauma, or seizure disorder
• Presence of other conditions causing cerebral edema (hyponatremia, hepatic encephalopathy)
• Conditions causing increased permeability of the blood-brain barrier (sepsis, meningitis, encephalitis, hemolytic uremic syndrome, vasculitis)

    

https://www.ncbi.nlm.nih.gov/books/NBK559018/#:~:text=Introduction,miss%20their%20regular%20dialysis%20treatments

Neurological complications of ckd:-

Encephalopathy

Uremic encephalopathy

Wernicke's encephalopathy

Dialysis encephalopathy/dementia

Rejection encephalopathy

Hypertensive encephalopathy

Dysequilibrium syndrome

Fluid and electrolyte disturbances

Drug toxicity

Presumed pathophysiology

Accumulation neurotoxins

Disturbances in intermediary metabolism

Hormonal disturbances

Thiamine deficiency

Aluminum accumulation

Cytokine production due to the rejection process

Cerebral vasogenic edema

Reverse urea effect

Intracellular acidosis in cerebral cortex

1 Calcium, magnesium, sodium disturbances, osmolality

Drugs metabolized or excreted by kidney

Immunosuppressive drugs

Approach to case of lower limb weakness