Uremic encephalopathy, diabetes, and halucinations

Question

I'm in highschool, interested in patient diagnosis and treatment and that's why I'm asking this question. I've recently heard about a patient with end-stage uremic encephalopathy and diabets. He has delirium and he stoped dialytic therapy because of his halucinations (he ripped off the medical equipment). He had been going to dialys three times a week for 15 years. He has about 70 years old. He doesn't present any signs of dementia. I assumed halucinations started because of the higher level of urea. Anti-pshichotic didn't worked on him. Without dialys theraphy, he'd probably die in a few days. I'm really interested in this case and curious about the treatment. Isn't something left to do? All the best!

Answer 1

The treatment for uremic encephalopathy is dialysis of some sort - peritoneal, etc. - or a kidney transplant, of course. But the latter is not the immediate treatment of choice.

Looking for why delirium suddenly occurred is important; not all delirium in dialysis patients is due to uremic encephalopathy (e.g. rule out rule out cerebrovascular accident, intracranial mass, hyper/hyponatremia, hyperglycemia, and hyperosmolar syndromes as the cause of encephalopathy, etc.)

If the cause is uremic encephaopathy, maybe one can mitigate the symptoms by correction of any existing anemia or calcium and phosphate abnormalities, but the fact remains: assessing the adequacy of dialysis and restarting adequate dialysis is the treatment.

_{Uremic Encephalopathy}