A dialysis-dependent patient missed their last dialysis treatment and shows signs of muscle twitching and confusion. What electrolyte imbalance is likely present?

The correct answer is hyperkalemia. In patients with end-stage renal disease who are dependent on dialysis, the kidneys are unable to effectively excrete potassium. When a dialysis treatment is missed, levels of potassium can rise significantly. This is particularly critical because elevated potassium has profound effects on muscle function and cardiac rhythm, which can lead to symptoms like muscle twitching and confusion.

Dialysis helps to remove excess potassium from the body, so when it's missed, there is a substantial risk of hyperkalemia developing. The muscle twitching may occur due to the impact of elevated potassium levels on neuromuscular excitability, while confusion can result from the effects on the central nervous system. Understanding the relationship between dialysis, kidney function, and potassium is essential in managing patients and predicting potential complications when dialysis is not performed as scheduled.