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Uremic Encephalopathy - Coggle Diagram
Uremic Encephalopathy
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Diagnose
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Physical
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Hyperreflexia, clonus, asterixis
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Lab
Renal function studies [12] – Markedly elevated blood urea nitrogen (BUN) and creatinine levels are seen in uremic encephalopathy
Serum electrolyte and glucose measurements – To rule out hyponatremia, hypernatremia, hyperglycemia, and hyperosmolar syndromes as the cause of encephalopathy
Complete blood cell count – To detect leukocytosis, which may suggest an infectious cause, and to determine whether anemia is present (anemia may contribute to the severity of mental alterations)
Serum calcium, phosphate, and parathyroid hormone (PTH) levels – To assess for hypercalcemia, hypophosphatemia, and severe hyperparathyroidism, which cause metabolic encephalopathy
Serum magnesium level – This may be elevated in a patient with renal insufficiency, particularly if the patient is ingesting magnesium-containing antacids; hypermagnesemia may manifest as encephalopathy
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Edukasi
Administer medications (eg, iron, erythropoietin, phosphate binders, vitamin D analogues) for patients with ESRD to optimize their quality of life.
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Patofisiologi
One contributing factor to uremic encephalopathy may involve imbalances of neurotransmitter amino acids within the brain. During the early phase of uremic encephalopathy, plasma and cerebrospinal fluid (CSF) determinations indicate that levels of glycine increase and levels of glutamine and gamma-aminobutyric acid (GABA) decrease. As uremia progresses, it has been proposed that the accumulation of guanidino compounds results in activation of excitatory N-methyl-D-aspartate (NMDA) receptors and inhibition of inhibitory GABA receptors, which may cause myoclonus and seizures.
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