Nephron 18: 352-353 (1977)
Peritoneal Dialysis: A Temporizing Means for Hemodialysis Patients with Subdural Hematomas Georgetta Bidwell, Donald Sherrard and Meredith Mathews University of Washington and Veterans Administration Hospital, Seattle, Wash.
Key Words. Subdural hematomas • Peritoneal dialysis • Hemodialysis Abstract. Subdural hematoma has a higher mortality rate with hemodialysis patients than the normal population. One reason for this is the coagulation abnormalities of hemodialyzed patients. One case of a successfully treated subdural hematoma in a chronic peritoneal dialysis patient is presented. Changing the mode of dialysis from hemodialysis to peritoneal dialysis in a patient suspected of having a subdural hematoma may be beneficial in improving overall survival.
Case Report A 65-year-old female with end stage renal disease secondary to polycystic kidney disease has been treated with chronic peritoneal dialysis since October 1972 (3 years). 1 month prior to admission, she sus tained a head injury in a fall. There was no history of
loss o f consciousness, but in the following m onth her daughter observed increasing lethargy, personality changes and recurrent falls. Admission physical exami nation revealed a lethargic female with no focal neuro logical signs. H er blood pressure was 162/94, pulse 94 and regular and weight was 51.4 kg. Laboratory data included the following: BUN 75 mg% , N a 145 mEq/1, Cl 102 mEq/l, HCO 33 mEq/1, K 3.17 mEq/1 glucose 127 mg% and Ca 9.3 mg%. Clotting studies were normal. The patient became progressively lethargic during her hospitalization. EEG showed mixed 0-8-waves, moder ately severe and generalized. A brain scan demonstrated a left fronto-parietal mass consistent with hematoma. The diagnosis o f a left convexity subdural hematoma was confirmed by its evacuation. 2 months later the patient is again at home on peritoneal dialysis main taining the high level of activity and sociability char acteristic o f her life style before the injury.
This surprisingly benign course was in marked contrast to the cases recently described
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In a recent article Leonard and Shapiro [1] present several risk factors for hemodialysis patients with subdural hematomas. These in clude vascular access problems, anticoagu lants, hypertension, marked weight gain and urea shifts. The poorer survival among hemo dialysis patients as compared with the general population may be related to these factors [2]. We would like to present one case of subdural hematoma in a patient on chronic peritoneal dialysis.
Bidwell/Sherrard/Mathews
References 1
2
Leonard, A. and Shapiro, F .: Subdural hematoma in regularly hemodialyzed patients. Ann. intern. Med. 82: 650-658 (1975). Richards, T. and Hoff, J . : Factors affecting survival from acute subdural hematomas. Surgery, St. Louis 75: 253-258 (1974).
Received: March 18, 1976 Accepted: August 18, 1976 Georgetta Bidwell, MD, University o f Washington and Veterans Administration Hospital, Seattle, WA 98108 (USA)
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[1]. As was suggested, peritoneal dialysis avoids several features of hemodialysis (e.g. anticoagulation, rapid weight change, urea shift) which may increase the danger of sub dural hematoma. Because chronic peritoneal dialysis is not widely used it may be a long time before another patient using this treat ment sustains such an injury. Therefore, we felt it worthwhile to report a single case de monstrating the safety of peritoneal dialysis in a patient with subdural hematoma and renal failure. This case lends support to the recom mendation of Leonard and Shapiro [I] that peritoneal dialysis be tried in such cases.
353
Peritoneal Dialysis: A Temporizing Means for Hemodialysis Patients with Subdural Hematomas Georgetta Bidwell, Donald Sherrard and Meredith Mathews University of Washington and Veterans Administration Hospital, Seattle, Wash.
Key Words. Subdural hematomas • Peritoneal dialysis • Hemodialysis Abstract. Subdural hematoma has a higher mortality rate with hemodialysis patients than the normal population. One reason for this is the coagulation abnormalities of hemodialyzed patients. One case of a successfully treated subdural hematoma in a chronic peritoneal dialysis patient is presented. Changing the mode of dialysis from hemodialysis to peritoneal dialysis in a patient suspected of having a subdural hematoma may be beneficial in improving overall survival.
Case Report A 65-year-old female with end stage renal disease secondary to polycystic kidney disease has been treated with chronic peritoneal dialysis since October 1972 (3 years). 1 month prior to admission, she sus tained a head injury in a fall. There was no history of
loss o f consciousness, but in the following m onth her daughter observed increasing lethargy, personality changes and recurrent falls. Admission physical exami nation revealed a lethargic female with no focal neuro logical signs. H er blood pressure was 162/94, pulse 94 and regular and weight was 51.4 kg. Laboratory data included the following: BUN 75 mg% , N a 145 mEq/1, Cl 102 mEq/l, HCO 33 mEq/1, K 3.17 mEq/1 glucose 127 mg% and Ca 9.3 mg%. Clotting studies were normal. The patient became progressively lethargic during her hospitalization. EEG showed mixed 0-8-waves, moder ately severe and generalized. A brain scan demonstrated a left fronto-parietal mass consistent with hematoma. The diagnosis o f a left convexity subdural hematoma was confirmed by its evacuation. 2 months later the patient is again at home on peritoneal dialysis main taining the high level of activity and sociability char acteristic o f her life style before the injury.
This surprisingly benign course was in marked contrast to the cases recently described
Downloaded by: King's College London 137.73.144.138 - 1/20/2019 5:31:53 AM
In a recent article Leonard and Shapiro [1] present several risk factors for hemodialysis patients with subdural hematomas. These in clude vascular access problems, anticoagu lants, hypertension, marked weight gain and urea shifts. The poorer survival among hemo dialysis patients as compared with the general population may be related to these factors [2]. We would like to present one case of subdural hematoma in a patient on chronic peritoneal dialysis.
Bidwell/Sherrard/Mathews
References 1
2
Leonard, A. and Shapiro, F .: Subdural hematoma in regularly hemodialyzed patients. Ann. intern. Med. 82: 650-658 (1975). Richards, T. and Hoff, J . : Factors affecting survival from acute subdural hematomas. Surgery, St. Louis 75: 253-258 (1974).
Received: March 18, 1976 Accepted: August 18, 1976 Georgetta Bidwell, MD, University o f Washington and Veterans Administration Hospital, Seattle, WA 98108 (USA)
Downloaded by: King's College London 137.73.144.138 - 1/20/2019 5:31:53 AM
[1]. As was suggested, peritoneal dialysis avoids several features of hemodialysis (e.g. anticoagulation, rapid weight change, urea shift) which may increase the danger of sub dural hematoma. Because chronic peritoneal dialysis is not widely used it may be a long time before another patient using this treat ment sustains such an injury. Therefore, we felt it worthwhile to report a single case de monstrating the safety of peritoneal dialysis in a patient with subdural hematoma and renal failure. This case lends support to the recom mendation of Leonard and Shapiro [I] that peritoneal dialysis be tried in such cases.
353
