const pptxgen = require('pptxgenjs');

const pptx = new pptxgen();
pptx.layout = 'LAYOUT_WIDE'; // 13.3 x 7.5
pptx.author = 'Orris';
pptx.title = 'Dialysis Disequilibrium Syndrome Poster';
pptx.subject = 'Clinical quick-reference poster';
pptx.company = 'Medical Education';
pptx.lang = 'en-US';

const slide = pptx.addSlide();

// Background
slide.addShape(pptx.ShapeType.rect, {
  x: 0,
  y: 0,
  w: 13.3,
  h: 7.5,
  fill: { color: 'F4F8FF' },
  line: { color: 'F4F8FF' }
});

// Header band
slide.addShape(pptx.ShapeType.rect, {
  x: 0,
  y: 0,
  w: 13.3,
  h: 0.95,
  fill: { color: '0D3B66' },
  line: { color: '0D3B66' }
});

slide.addText('DIALYSIS DISEQUILIBRIUM SYNDROME (DDS)', {
  x: 0.35,
  y: 0.16,
  w: 8.9,
  h: 0.36,
  fontFace: 'Arial',
  fontSize: 24,
  bold: true,
  color: 'FFFFFF'
});

slide.addText('Recognition, Intradialytic Management, and Medication', {
  x: 0.35,
  y: 0.52,
  w: 8.9,
  h: 0.24,
  fontFace: 'Arial',
  fontSize: 12,
  color: 'D9E9FF'
});

// Warning tag
slide.addShape(pptx.ShapeType.roundRect, {
  x: 9.55,
  y: 0.2,
  w: 3.4,
  h: 0.52,
  rectRadius: 0.07,
  fill: { color: 'FFB703' },
  line: { color: 'FFB703' }
});
slide.addText('Neurologic emergency during/after dialysis', {
  x: 9.75,
  y: 0.33,
  w: 3.0,
  h: 0.18,
  fontSize: 11,
  bold: true,
  color: '4A2A00',
  fontFace: 'Arial',
  align: 'center'
});

// Left column: indications/risk + symptoms
slide.addShape(pptx.ShapeType.roundRect, {
  x: 0.35,
  y: 1.15,
  w: 4.1,
  h: 5.85,
  rectRadius: 0.05,
  fill: { color: 'FFFFFF' },
  line: { color: 'B7CDE8', pt: 1 }
});

slide.addText('1) INDICATION / RISK SITUATIONS', {
  x: 0.55,
  y: 1.35,
  w: 3.7,
  h: 0.28,
  fontSize: 14,
  bold: true,
  color: '0D3B66'
});

const riskBullets = [
  'Usually during or shortly after first several dialysis sessions',
  'High risk: severe azotemia, first dialysis, high-efficiency dialysis',
  'Also reported with peritoneal dialysis and maintenance hemodialysis',
  'More likely in pediatric and older adult patients',
  'Pathogenesis: rapid solute (urea) removal → osmotic gradient → cerebral edema'
];

slide.addText(
  riskBullets.map((b, i) => ({ text: b, options: { bullet: { indent: 14 }, breakLine: i !== riskBullets.length - 1 } })),
  {
    x: 0.62,
    y: 1.72,
    w: 3.65,
    h: 1.92,
    fontSize: 11,
    color: '1F2D3D',
    valign: 'top'
  }
);

slide.addShape(pptx.ShapeType.line, {
  x: 0.55,
  y: 3.75,
  w: 3.7,
  h: 0,
  line: { color: 'D5E3F2', pt: 1 }
});

slide.addText('SIGNS & SYMPTOMS', {
  x: 0.55,
  y: 3.9,
  w: 3.6,
  h: 0.26,
  fontSize: 14,
  bold: true,
  color: '0D3B66'
});

const symptomBullets = [
  'Early: headache, visual disturbance, nausea, vomiting, agitation, muscle cramps, irritability',
  'Progressive: delirium, lethargy, drowsiness, confusion, hypertension',
  'Severe: seizures, coma, death (rare if promptly treated)',
  'Timing: often in 3rd–4th hour of dialysis; may occur up to 8–48 hours post-dialysis'
];

slide.addText(
  symptomBullets.map((b, i) => ({ text: b, options: { bullet: { indent: 14 }, breakLine: i !== symptomBullets.length - 1 } })),
  {
    x: 0.62,
    y: 4.25,
    w: 3.65,
    h: 2.45,
    fontSize: 11,
    color: '1F2D3D',
    valign: 'top'
  }
);

// Middle column: management during dialysis
slide.addShape(pptx.ShapeType.roundRect, {
  x: 4.6,
  y: 1.15,
  w: 4.1,
  h: 5.85,
  rectRadius: 0.05,
  fill: { color: 'FFFFFF' },
  line: { color: 'B7CDE8', pt: 1 }
});

slide.addText('2) MANAGEMENT DURING DIALYSIS', {
  x: 4.8,
  y: 1.35,
  w: 3.7,
  h: 0.28,
  fontSize: 14,
  bold: true,
  color: '0D3B66'
});

// Flow illustration
slide.addShape(pptx.ShapeType.roundRect, {
  x: 4.9,
  y: 1.75,
  w: 3.5,
  h: 0.52,
  rectRadius: 0.05,
  fill: { color: 'E8F1FF' },
  line: { color: '8CB3E6' }
});
slide.addText('Suspect DDS (neurologic symptoms)', {
  x: 5.02,
  y: 1.93,
  w: 3.26,
  h: 0.2,
  fontSize: 10.5,
  bold: true,
  color: '0D3B66',
  align: 'center'
});

slide.addShape(pptx.ShapeType.chevron, {
  x: 6.22,
  y: 2.30,
  w: 0.9,
  h: 0.28,
  fill: { color: '7AA6DC' },
  line: { color: '7AA6DC' },
  rotate: 90
});

slide.addShape(pptx.ShapeType.roundRect, {
  x: 4.9,
  y: 2.62,
  w: 3.5,
  h: 0.62,
  rectRadius: 0.05,
  fill: { color: 'FFE8E8' },
  line: { color: 'D97272' }
});
slide.addText('STOP dialysis or reduce efficiency immediately', {
  x: 5.03,
  y: 2.83,
  w: 3.24,
  h: 0.2,
  fontSize: 10.5,
  bold: true,
  color: '8A1F1F',
  align: 'center'
});

slide.addShape(pptx.ShapeType.chevron, {
  x: 6.22,
  y: 3.30,
  w: 0.9,
  h: 0.28,
  fill: { color: '7AA6DC' },
  line: { color: '7AA6DC' },
  rotate: 90
});

slide.addShape(pptx.ShapeType.roundRect, {
  x: 4.9,
  y: 3.62,
  w: 3.5,
  h: 0.72,
  rectRadius: 0.05,
  fill: { color: 'E9FBEF' },
  line: { color: '66B27A' }
});
slide.addText('Increase serum osmolality\n(Mannitol or Hypertonic Saline)', {
  x: 5.03,
  y: 3.80,
  w: 3.24,
  h: 0.45,
  fontSize: 10.5,
  bold: true,
  color: '1F6B35',
  align: 'center'
});

const manageBullets = [
  'Close neurologic monitoring and airway protection if severe encephalopathy',
  'For prevention in high-risk patients: lower dialysis efficiency, slower urea reduction, higher dialysate sodium, consider prophylactic mannitol',
  'Symptoms are often self-limited once osmotic shift is corrected',
  'Evaluate alternative dangerous diagnoses if atypical: e.g., subdural hematoma, PRES, severe metabolic derangement'
];

slide.addText(
  manageBullets.map((b, i) => ({ text: b, options: { bullet: { indent: 14 }, breakLine: i !== manageBullets.length - 1 } })),
  {
    x: 4.9,
    y: 4.53,
    w: 3.6,
    h: 2.2,
    fontSize: 11,
    color: '1F2D3D',
    valign: 'top'
  }
);

// Right column: medication + mini infographic
slide.addShape(pptx.ShapeType.roundRect, {
  x: 8.85,
  y: 1.15,
  w: 4.1,
  h: 5.85,
  rectRadius: 0.05,
  fill: { color: 'FFFFFF' },
  line: { color: 'B7CDE8', pt: 1 }
});

slide.addText('3) MEDICATION TO TREAT', {
  x: 9.05,
  y: 1.35,
  w: 3.7,
  h: 0.28,
  fontSize: 14,
  bold: true,
  color: '0D3B66'
});

slide.addShape(pptx.ShapeType.rect, {
  x: 9.05,
  y: 1.74,
  w: 3.7,
  h: 1.07,
  fill: { color: 'FFF8E6' },
  line: { color: 'E9CD84' }
});

slide.addText('First-line osmotherapy', {
  x: 9.17,
  y: 1.86,
  w: 3.4,
  h: 0.22,
  fontSize: 12,
  bold: true,
  color: '7A5A00'
});
slide.addText('• Mannitol 0.25 g/kg IV\n• or Hypertonic saline 10% to 23% (5 mL IV)', {
  x: 9.22,
  y: 2.10,
  w: 3.3,
  h: 0.58,
  fontSize: 10.8,
  color: '3E3A2B'
});

slide.addShape(pptx.ShapeType.rect, {
  x: 9.05,
  y: 2.95,
  w: 3.7,
  h: 1.26,
  fill: { color: 'EEF5FF' },
  line: { color: 'A8C4EA' }
});
slide.addText('Adjunctive medication notes', {
  x: 9.17,
  y: 3.08,
  w: 3.4,
  h: 0.22,
  fontSize: 12,
  bold: true,
  color: '0D3B66'
});
slide.addText('• Seizure control may be needed if convulsions occur\n• Choose antiepileptics carefully in ESKD (renal dosing/toxicity risk)\n• Definitive control is correction of uremia/osmotic imbalance', {
  x: 9.22,
  y: 3.32,
  w: 3.35,
  h: 0.83,
  fontSize: 10.2,
  color: '1F2D3D'
});

slide.addShape(pptx.ShapeType.roundRect, {
  x: 9.05,
  y: 4.38,
  w: 3.7,
  h: 2.2,
  rectRadius: 0.05,
  fill: { color: 'F8FAFD' },
  line: { color: 'D2DEEE' }
});

slide.addText('Quick Illustration: Why DDS happens', {
  x: 9.2,
  y: 4.54,
  w: 3.35,
  h: 0.22,
  fontSize: 11.5,
  bold: true,
  color: '0D3B66',
  align: 'center'
});

// blood box
slide.addShape(pptx.ShapeType.roundRect, {
  x: 9.28,
  y: 4.9,
  w: 1.45,
  h: 0.65,
  rectRadius: 0.05,
  fill: { color: 'DDEEFF' },
  line: { color: '8CB3E6' }
});
slide.addText('Blood\nOsm ↓ fast', {
  x: 9.33,
  y: 5.03,
  w: 1.35,
  h: 0.4,
  fontSize: 9.6,
  align: 'center',
  color: '0D3B66',
  bold: true
});

// brain box
slide.addShape(pptx.ShapeType.roundRect, {
  x: 11.13,
  y: 4.9,
  w: 1.45,
  h: 0.65,
  rectRadius: 0.05,
  fill: { color: 'FFE7E7' },
  line: { color: 'D98888' }
});
slide.addText('Brain\nOsm stays ↑', {
  x: 11.18,
  y: 5.03,
  w: 1.35,
  h: 0.4,
  fontSize: 9.6,
  align: 'center',
  color: '8A1F1F',
  bold: true
});

// arrows water shift
slide.addShape(pptx.ShapeType.chevron, {
  x: 10.75,
  y: 5.0,
  w: 0.35,
  h: 0.22,
  fill: { color: '4A90E2' },
  line: { color: '4A90E2' }
});
slide.addShape(pptx.ShapeType.chevron, {
  x: 10.95,
  y: 5.22,
  w: 0.35,
  h: 0.22,
  fill: { color: '4A90E2' },
  line: { color: '4A90E2' }
});
slide.addText('Water shifts into brain → edema', {
  x: 9.25,
  y: 5.67,
  w: 3.35,
  h: 0.2,
  fontSize: 9.8,
  align: 'center',
  color: '3E4A59'
});

slide.addText('Key takeaway: prevent with gentler initial dialysis and prompt osmotherapy when symptomatic.', {
  x: 9.2,
  y: 5.95,
  w: 3.4,
  h: 0.46,
  fontSize: 10,
  bold: true,
  color: '1F6B35',
  align: 'center'
});

// Footer references
slide.addShape(pptx.ShapeType.rect, {
  x: 0,
  y: 7.08,
  w: 13.3,
  h: 0.42,
  fill: { color: 'E6EEF8' },
  line: { color: 'E6EEF8' }
});

slide.addText('References: Tintinalli\'s Emergency Medicine, p. 618 | Brenner and Rector\'s The Kidney (Clinical Features/Prevention) | Adams and Victor\'s Principles of Neurology (DDS symptom timing)', {
  x: 0.25,
  y: 7.2,
  w: 12.8,
  h: 0.18,
  fontSize: 8.4,
  color: '3E4A59'
});

pptx.writeFile({ fileName: '/home/daytona/workspace/dds-poster/Dialysis_Disequilibrium_Syndrome_Poster.pptx' });