Delayed Clinical Response to Hemodialysis in a Patient With Uremia

Abstract

ALTHOUGH THE GENESIS of the toxic state in uremia is not well understood, nearly all of its symptoms may be relieved by adequate hemodialysis. Maximum symptomatic and objective benefit are almost invariably evident within 48 hours of dialysis. This is the report of a uremic patient whose maximum improvement occurred 70 to 96 hours after dialysis. Report of a Case The patient was a 50-year-old white male physician who had chronic renal insufficiency from what was subsequently found to be chronic pyelonephritis with papillary necrosis. Symptoms and signs of uremia (nausea, fatigability, azotemia) were first noted in April 1965. He was admitted to Riverside Methodist Hospital in coma onMay 2. Physical examination revealed a comatose patient whose blood pressure was 160/100 mm Hg and no other abnormal findings. The relevant laboratory findings are recorded in the Table. On May 4, a six-hour hemodialysis was done with the Kolff twin