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Kidney Week

Abstract: SA-PO131

A Case of Atypical Manifestation of Uremic Encephalopathy: Acute Psychosis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Dodbiba, Kristi, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Pennekamp, Alexander Mark, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Chen, Huiwen, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Introduction

Uremic encephalopathy UE is a cerebral dysfunction caused by the accumulation of toxins resulting from acute or chronic renal failure. The clinical presentation is broad, and the clinical course is always progressive when untreated. Patients generally exhibit the signs of UE when glomerular filtration rate is less than 15 ml/min/1.73 m2 and the symptoms usually include fatigue, nausea, restlessness, drowsiness and diminished ability to concentrate. Paranoia is sometimes described as a uremic presentation, but rarely do patients exhibit acute psychosis. Here we present a patient with acute psychosis as her first sign of uremic encephalopathy.

Case Description

The patient is a 66-year-old female with past medical history of CKD stage III with baseline 2.4 mg/dl, coronary artery disease status post percutaneous coronary intervention, HFpEF, DM2 who presented to the hospital after failing outpatient management of mastitis. Her hospital course was complicated by acute kidney injury stage II, mild hyperkalemia and acute pychosis. Her manifestations include vocalization of her displeasure of the hosptal, aggressive language, noncompliance to the treatment plan and severe paranoia. Patient did not have any psychiatric history. Her peak BUN was 59 and peak creatinine was 5.68 mg/dl. She was deemed to be competent by the psychiatry team. Antipsychotics were given for paranoia, but her conditions did not improve. However, her mental status improved drastically after two sessions of dialysis treatment.

Discussion

Timing of dialysis initiation is an important topic in nephrology. The current practice is to delay dialysis unless there is an absolute indication. Uremic encephalopathy is a clinical diagnosis and can have various presentations, most notably catatonia or hypoactive symptoms. Acute psychosis is a very atypical presention of uremia and can be missed as an indication for dialysis initiation. In our patient, delayed dialysis would significantly impacted the delivery of her overall care due to her psychosis.