Nausea with hemodialysis

A 61-year-old woman developed a bradydysrhythmia after a cardiac arrest (57). Her lactate concentration was 18 mmol/1, pH 6.60, blood glucose 19 mmol/1, and creatinine 1136 pmol/1. She had a 5-year history of type 2 diabetes treated with glimepiride 3 mg/day and metformin 850 mg tds, and 4 months before admission had had a serum creatinine concentration of 1.1 mg/dl. In the few days before admission she had had abdominal pain, nausea, and a speech disorder. She was treated with hemodialysis, and 6 weeks later the creatinine was 0.54 mg/dl. Further information about events leading to the acute renal insufficiency was not given, but a diagnosis of metformin-associated lactic acidosis was made. 

A 67-year-old woman took about 7 g of procainamide and developed nausea, vomiting, lethargy, a junctional tachycardia, hypotension, and oliguria (61). She was treated with hemodialysis. 

A 42-year-old man developed nausea and vomiting and felt suicidal. He had type 2 diabetes and was taking metformin (56). His blood lactate concentration was 8.9 mmol/1, bicarbonate 16 mmol/1, and pH 7.2. Severe hypotension required intensive care. The lactate concentration rose to 22 mmol/1 and the bicarbonate fell to 6.7 mmol/1 and the pH to 6.89. The metformin concentration was high at 191 mg/1. He survived, having been treated with intermittent hemodialysis. 

In an open trial, 7-day triple therapy with omeprazole 30 mg bd, amoxicillin 500 mg tds, and clarithromycin 400 mg bd was safe and effective in eradicating H. pylori in 12 of 13 patients undergoing hemodialysis (10). There were adverse effects in two patients (compared with three of 27 patients not undergoing hemodialysis) and treatment had to be discontinued in one, owing to severe nausea and vomiting. 

The renal toxins of A. smithiana are identified as allenic norleucine and chlorocrotylglycine [102]. Poisoning with A. smithiana which were mistaken for the edible Tricholoma magnivelare (edible pine mushroom or matsutake) was reported in three Asian patients in the Pacific Northwest and two patients in Taiwan [103,104]. Nausea, vomiting, water diarrhea and abdominal discomfort without liver injury developed 4-11 hours post ingestion. Renal failure occurred 2 to 4 days later and temporary required hemodialysis. After several weeks, renal function recovered to the basehne level [104]. 

The most common complications that occur during the hemodialysis procedure include hypotension, cramps, nausea and vomiting, headache, chest pain, hack pain, and fever or chiUs. Table 45-3 hsts these comphcations and the etiology with predisposing factors... 

Dialysis In a 26-month observational study, fever, chills, and nausea were recorded in 13 of 136 patients undergoing hemodialysis or CAPD within hours of a dose of gadolinium DTPA used for cardiovascular evaluation before transplantation [31 ]. No other susceptibility factor was identified. The authors suggested that such reactions may be relevant to the poorly understood pathogenesis of skin reactions to some gadolinium-containing products in patients with end-stage renal disease. 

Excess copper is the result of either excessive copper absorption or ineffective copper excretion. The most common diseases associated with copper excess are (1) Wilson s disease, a genetic disease resulting in mutations in the Wilson s disease P-type ATPase and excessive hepatocyte copper accumulation (2) renal disease, in patients on hemodialysis due to kidney failure when dialysate solutions become contaminated with excess copper and (3) biliary obstruction. Excessive use of copper supplements may also contribute to copper toxicity and is clinically manifested by severe anemia, nausea and vomiting, abdominal pain, and diarrhea. 

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