Document Detail

Severe electrolyte disturbances in lethal subclavian catheter dialysis.
MedLine Citation:
PMID:  8024486     Owner:  NLM     Status:  MEDLINE    
Syncope, irreversible shock, and respiratory and circulatory arrest developed in a 54-year-old diabetic man chronically dialyzed with a subclavian catheter (SC) minutes after the end of a dialysis session. Resuscitation attempts remained unsuccessful. During the resuscitation attempt, a blood analysis showed severe hyponatremia, acidosis, and hypochloremia. Respiratory and cardiac arrest developed during dialysis in a 64-year-old woman on chronic SC dialysis. Resuscitation was unsuccessful; chloremia levels were 79 mEq/L, and calcemia levels were 20 mg%. Both patients were dialyzed with a standard dialysate solution. The reasons for the electrolyte disturbances could not be explained technically. The autopsy showed myocardial perforation by the SC and accumulation in the pericardium of the fluids administered during the resuscitation attempt (e.g., glucose 5%, bicarbonate, Ca gluconate, human albumines), thus explaining the erroneous electrolyte results. The reason for the perforation was a too-rigid central femoral vein catheter, erroneously labeled a subclavian catheter by the supplying firm. Because of a syndrome of progressive vena subclavia and vena cava sclerosis with insufficient arterial phase flow and venous-phase bleeding around the puncture site during single-needle dialysis, the original SC had to be replaced by a longer one with the tip located in the atrium (this SC was actually a femoral catheter). Analysis of the fluid aspirated through the SC can determine the diagnosis in sudden death of SC dialysis patients.
R Hombrouckx; J Y De Vos; L Larno
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Artificial organs     Volume:  18     ISSN:  0160-564X     ISO Abbreviation:  Artif Organs     Publication Date:  1994 Apr 
Date Detail:
Created Date:  1994-08-04     Completed Date:  1994-08-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802778     Medline TA:  Artif Organs     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  325-7     Citation Subset:  IM    
Dialysis Unit, Kliniek Hogerlucht, Ronse, Belgium.
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MeSH Terms
Catheterization, Central Venous / adverse effects*
Catheters, Indwelling / adverse effects
Fatal Outcome
Heart Injuries / etiology
Middle Aged
Renal Dialysis*
Subclavian Vein*
Water-Electrolyte Imbalance / etiology*
Wounds, Penetrating / etiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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