Seizures during dialysis are not common. But they happen. And they can be scary.
There are several reasons a person undergoing dialysis may have a seizure. This blog post will explore some of them.
Low blood sugar
If your blood sugar drops very low it can cause seizures. And this happens not just in dialysis. Because the brain needs sugar to carry out its function, a low blood sugar can lead to seizures.
People with kidney failure are vulnerable to low blood sugar levels. Under normal circumstances the kidney breaks down some of the insulin in the body. Remember that insulin helps the body break down glucose thus leading to a fall in blood glucose. When a person has kidney failure, the person no longer breaks down insulin quickly. This means that insulin stays longer in the body system putting the person at risk of having low blood sugar levels.
Many people with kidney failure have a poor appetite, so it is not unusual to eat very little in a day. This can lead to dangerously low levels of blood sugar.
Some symptoms that may appear if you have low glucose levels are headache, irritability, hunger, dizziness,, palpitations, inability to concentrate and others.
Dialysis disequilbrium syndrome
This results from some shifts of key electrolytes in the brain. This complication of dialysis is typically seen in the first session of dialysis or in people who have not had dialysis for a while and so they have very high levels of toxins and electrolyte shifts.
Following dialysis, the body cannot keep up with the rapid removal of wastes and this causes some imbalance between electrolytes inside the cells and those outside.
Other symptoms of dialysis disequilbrium syndrome (DDS) include headache, blurred vision, confusion, restlessness and even coma.
If a person were to develop DDS it i more likely to occur later in the dialysis than earlier
Uraemia
Seizures may occur as part of the complications of CKD and not necessarily as a result of the dialysis process.
When a person has kidney failure, they have trouble removing toxins form their body. For people who pay fully or partially for dialysis out-of-pocket, it is common for them to delay dialysis for as long as possible.
Some of them eventually experience the symptoms of toxin build up following delayed dialysis. One such symptom is seizure, and this typically occurs early on in the dialysis process
Drugs
Certain anti-seizure drugs are removed by dialysis. If you are on medications to stop seizures and these drugs are removed during dialysis, it makes you prone to having seizures. Some seizure medicaion removed by dialysis include levetiracetam, ethosuximide and pregabalin.
Others
Finally, the reason you had the seizure may have no relationship with the dialysis at all.
What’s the next step after seizures?
Usually your doctor will evaluate you to know why you had a seizure. One of the first thing that would be done is a blood sugar level. If you have low blood sugar, you’ll likely be given dextrose infusion. Your healthcare team may also suggest you always eat before undergoing dialysis.
Other investigations that may be requested are calcium, magnesium and sodium levels.
For seizures caused by dialyzable drugs, the doctor may adjust the dose of your medications. Alternatively, they may chose to change your medications to something not removed from the blood by dialysis.
If the cause of the seizure is not clear, you will have a full work up just like anyone else not on dialysis who develops seizures. Tests may include imaging like CT scans or blood work up.
Wrap up
Seizures are frightening events that may occur during dialysis. Your healthcare team will try to determine why it happened. Thereafter, measures will be instituted to prevent further occurence
