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Dialysis Disequilibrium Syndrome

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Dialysis Disequilibrium Syndrome, Hemodialysis Disequilibrium Syndrome

  • See Also
  1. Hemodialysis
  2. Dialysis Emergencies
  3. Hypotension in the Dialysis Patient
  4. End Stage Renal Disease
  5. Bloodstream Infections in Hemodialysis
  • Epidemiology
  1. Rare, but potentially lethal
  1. Increased Intracranial Pressure
  2. Rapid decrease in Serum Osmolality during Dialysis
  • Symptoms
  1. Onset within 12 hours of Dialysis
  2. General
    1. Malaise
    2. Nausea or Vomiting
    3. Muscle cramping
  3. Cardiovascular
    1. Hypertension
  4. Neurologic
    1. Headache
    2. Motor Restlessness
    3. Confusion
    4. Altered Level of Consciousness
    5. Seizures
  • Differential Diagnosis
  1. Malignancy
  2. Ventricular Arrhythmia
  3. Subdural Hematoma
  4. Intracerebral abscess
  5. Meningitis
  6. Sepsis
  7. Hypertensive Encephalopathy
  8. Hyperkalemia
  9. Hypermagnesemia
  10. Hypercalcemia
  11. Hypoglycemia (or Hyperglycemia)
  • Diagnostics
  1. Electroencephalogram (EEG)
    1. Diffuse metabolic encephalopathy
  • Imaging
  1. MRI Brain (diffusion weighted)
    1. Osmotic demyelination of pons (and adjacent structures)
  • Management
  1. Seizure Prophylaxis
    1. Anticonvulsants
  2. Decrease cerebral edema
    1. Mannitol
    2. Hypertonic Saline
  • Prevention
  1. Decrease initial Dialysis flow rate and duration (especially if high urea concentration)
  • References
  1. Glauser (2013) Crit Dec Emerg Med 27(10): 2-12
  2. Shaikh (2010) J Emerg Trauma Shock 3(3): 300 [PubMed]