Case: 23 year old male is admitted to ICU after his hemodialysis session for extremely painful priapism.
Answer; Priapism is a rare and almost unheard complication of hemodialysis. Although exact pathophysiology is not known, the proposed mechanisms include epoetin alfa administration resulting in high hemoglobin levels and possibly heparin effect as anticoagulants have been known to cause priapism.
Other less known causes of priapism include spinal shock, antidepressants, malaria, spider toxins, total parenteral nutrition, and amyloidosis.
Shih WV, Wong C.- Priapism and hemodialysis: Case report and literature review. Clin Nephrol. 2018 Jul;90(1):64-70. doi: 10.5414/CN109416.