SEVERE ELECTROLYTE DISTURBANCES IN LETHAL SUBCLAVIAN CATHETER DIALYSIS

Syncope, irreversible shock, and respiratory and circulatory arrest de veloped in a 54-year-old diabetic man chronically dialyzed with a subc lavian catheter (SC) minutes after the end of a dialysis session. Resu scitation attempts remained unsuccessful. During the resuscitation att empt, a blood analysis showed severe hyponatremia, acidosis, and hypoc hloremia. Respiratory and cardiac arrest developed during dialysis in a 64-year-old woman on chronic SC dialysis. Resuscitation was unsucces sful; chloremia levels were 79 mEq/L, and calcemia levels were 20 mg%. Both patients were dialyzed with a standard dialysate solution. The r easons for the electrolyte disturbances could not be explained technic ally. The autopsy showed myocardial perforation by the SC and accumula tion in the pericardium of the fluids administered during the resuscit ation attempt (e.g., glucose 5%, bicarbonate, Ca gluconate, human albu mines), thus explaining the erroneous electrolyte results. The reason for the perforation was a too-rigid central femoral vein catheter, ero neously labeled a subclavian catheter by the supplying firm. Because o f a syndrome of progressive vena subclavia and vena cava sclerosis wit h insufficient arterial phase flow and venous-phase bleeding around th e puncture site during single-needle dialysis, the original SC had to be replaced by a longer one with the tip located in the atrium (this S C was actually a femoral catheter). Analysis of the fluid aspirated th rough the SC can determine the diagnosis in sudden death of SC dialysi s patients.