Confusion and Headaches After Dialysis: What to Know

Altered mental status?

Hello, Doctor Gao.
My mother returned from the hospital after dialysis on the second day of the Lunar New Year, complaining of a headache and experiencing confusion after 9 PM, sometimes not recognizing family members.
Her condition seems to fluctuate between good and bad.
What could this be, and what tests should be done?

Mr. Chen, 20~29 year old female. Ask Date: 2013/02/14

Dr. Gao Chunde reply Neurology

The consciousness fluctuates, and at times, the individual may not recognize family members, which raises the possibility of acute delirium.
Common causes include medications (such as cold medications, gastrointestinal drugs, and sedatives), infections (such as colds, urinary tract infections, gastroenteritis, and pneumonia; however, persistent headaches should raise concerns for central nervous system infections), and electrolyte imbalances (as indicated by blood tests for sodium, potassium, calcium, liver function tests, and kidney function tests).
Rarely, conditions like minor strokes or transient ischemic attacks may also be involved.
It is recommended that if symptoms do not improve, the individual should promptly visit a neurology outpatient clinic for evaluation and treatment.

Reply Date: 2013/02/14

More Info

Understanding confusion and headaches after dialysis can be quite complex, as these symptoms may arise from various underlying issues related to kidney function, fluid balance, and even neurological factors. Your mother’s experience of headaches and confusion, particularly after dialysis, warrants careful consideration and possibly further investigation.

Firstly, it’s important to recognize that dialysis is a treatment for kidney failure, and it can lead to several complications. One common issue is the fluctuation of electrolytes and fluid levels in the body. During dialysis, excess fluid and waste products are removed from the blood, which can sometimes lead to rapid changes in blood pressure and electrolyte imbalances. These fluctuations can cause headaches and confusion, especially if there is a significant drop in blood pressure or if the body is not able to maintain adequate blood flow to the brain.

Headaches in patients undergoing dialysis can also be attributed to several factors, including:
1. Dialysis-related headaches: These can occur due to changes in blood volume, blood pressure, or electrolyte levels during and after the dialysis session.
2. Uremic headaches: If the kidneys are not functioning adequately, toxins can build up in the blood, leading to uremia, which can cause headaches and cognitive changes.

3. Medication side effects: If your mother is on medications for blood pressure or other conditions, these could also contribute to headaches or confusion.

4. Dehydration or overhydration: Both conditions can lead to headaches. Dehydration can occur if too much fluid is removed during dialysis, while overhydration can happen if fluid intake is not properly managed.

5. Neurological issues: Confusion and cognitive changes can sometimes indicate more serious conditions, such as stroke, transient ischemic attacks (TIAs), or other neurological disorders. Given your mother’s symptoms of not recognizing family members, this possibility should be taken seriously.

Given these potential causes, it is crucial to consult with her healthcare provider. They may recommend several tests to better understand her condition, including:
- Blood tests: To check electrolyte levels, kidney function, and other relevant markers.

- Imaging studies: Such as a CT scan or MRI of the brain, to rule out any structural issues or acute neurological events.

- Neurological evaluation: A thorough assessment by a neurologist may be warranted if cognitive changes persist.

In the meantime, it’s essential to monitor her symptoms closely. Keeping a diary of when the headaches and confusion occur, their duration, and any associated symptoms can provide valuable information to her healthcare team. Additionally, ensuring she stays hydrated and follows any dietary recommendations from her nephrologist can help manage her symptoms.

In summary, while headaches and confusion after dialysis can be common, they should not be overlooked, especially when they involve cognitive changes. Prompt evaluation by her healthcare provider is essential to determine the underlying cause and to ensure appropriate management.

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