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Severe electrolyte disturbances in lethal subclavian catheter dialysis
R Hombrouckx1, J Y De Vos, L Larno
1Dialysis Unit, Kliniek Hogerlucht, Ronse, Belgium.
Artificial Organs
|April 1, 1994
Summary
Sudden death in dialysis patients can occur due to subclavian catheter misplacement. Autopsy revealed myocardial perforation and fluid accumulation, explaining electrolyte abnormalities and fatal outcomes.
Area of Science:
- Nephrology
- Cardiology
- Pathology
Background:
- Chronic hemodialysis patients often utilize subclavian catheters for vascular access.
- Sudden, unexplained deaths during or shortly after dialysis sessions pose a diagnostic challenge.
Observation:
- Two patients on chronic subclavian catheter dialysis experienced fatal syncope, shock, and arrest post-dialysis.
- Initial blood analyses revealed severe electrolyte disturbances (hyponatremia, acidosis, hypochloremia) and abnormal calcemia.
- Autopsy findings in both cases revealed myocardial perforation by the catheter and pericardial fluid accumulation.
Findings:
- The subclavian catheters were identified as misplaced femoral catheters, leading to myocardial perforation.
- Fluid administration during resuscitation efforts caused iatrogenic electrolyte abnormalities, masking the true cause of death.
- Analysis of fluid aspirated from the catheter may aid in diagnosing sudden death in dialysis patients.
Implications:
- Proper catheter identification and placement are critical to prevent fatal complications during dialysis.
- Autopsy and fluid analysis are essential for accurate diagnosis in sudden deaths associated with central venous catheters.
- This case highlights the importance of meticulous catheter management and verification in hemodialysis.