Q; 52 year old male with End Stage Renal Disease (ESRD) missed his two dialysis sessions in a row and admitted to ICU with volume overload, hyperkalemia, acidosis and acute uremic encephalopathy. The patient required intubation. Emergent dialysis is instituted. The patient recovered from all symptoms but remained lethargic preventing his liberation from the ventilator. What is the usual lag time between an institution of hemodialysis and resolution of acute uremic encephalopathy?
Answer: 24 - 48 hours
Fortunately, uremic encephalopathy is generally in direct proportion to the severity of azotemia. It takes about 24 to 48 hours in ESRD patients for mental status to be back to normal before uremic toxins clear.
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References:
Bolton, CF, Young, GB. Uremic encephalopathy. In: Bolton, CF, Young, GB, (Eds), Neurological Complications of Renal Disease, Buttersworth, Stoneham 1990. p.44.
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