Consciousness disturbed

Uremic and dialysis encephalopathies. Patients with renal failure continue to manifest neuropsychiatric symptoms despite significant advances in therapeutics and management. Patients with renal failure who are not yet on dialysis develop an array of symptoms, including clouding of consciousness, disturbed sleep patterns, tremor and asterixis that may progress to coma and death. 

General anesthesia is needed to perform hypothermia therapy. Without general anesthesia, the cerebral temperature cannot be lowered satisfactorily because of shivering, which usually starts at levels of 35°C. The requirement of anesthesia limits the indications for therapy. From an ethical viewpoint, general anesthesia may be permitted only in patients with consciousness disturbance. Hypothermia may be best indicated for patients with embolic occlusion of major cerebral arteries,... 

Shiba S, Sugiura K, Ebata A, et al. Hyponatremia with consciousness disturbance caused by omeprazole administration. A case report and literature review. Dig Dis Sci 1996 41(8) 1615-7. 

Mennecier D, Ceppa F, Gidenne S, Vergeau B. Hyponatremia with consciousness disturbance associated with esomeprazole. Ann Pharmacother 2005 39(4) 774-5. 

NetoMMetai, 1998 [4] 06 HD 4 PD 2 Hiccups, vomiting, insomnia, consciousness disturbance, seizures... 

Chang JMetai, 2000 [5] 20 HD 15 PD 4 Supportive 1 Hiccups, consciousness disturbance, numbness of iimbs, decreased muscie power, skin paresthesia, seizures... 

ChanYL etai, 2002 [11] 01 PD 1 Hiccups, consciousness disturbances, seizures... 

TseKCetai, 2003 [12] 06 PD 4 HD 1 Supportive 1 Hiccups, vomiting, consciousness disturbances, hyperkaiemia... 

Chen LLetai 2005 [18] 01 Supportive Hiccups, consciousness disturbances,... 

Chan YL et al [11] described one patient with severe intoxication who was submitted to HD 2 days after intoxication and died 7 weeks later with worsening of consciousness disturbances. 

All observations in our reports and reports from ofhers show fhaf sfar fruif intoxication may be harmful and even life fhreatening in patients with renal failure on supportive or dialytic treatment. Hiccups and vomiting, which are common symptoms, could be used as an indication of sfar fruit intoxication in renal patients presenting with neurological and consciousness disturbances that have no apparent cause. 

Chang CH, Yeh JH. Non-convulsive status epilepticus and consciousness disturbance after star fruit Averrhoa carambola) ingestion in a dialysis patient. Nephrology 2004 9 362-365... 

Fig. 3.13a-i. A 23-year-old man presenting with sudden headaches and vomiting but no neurologic deficit or consciousness disturbance. CT scan shows right cerebellar hematoma with intraventricular rupture and moderate ventricular dilatation (a). Left vertebral artery injection in AP (b) and lateral (c) views show an AVM of the right cerebellar... 

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