Dialysis Disequilibrium Syndrome

Aka: Dialysis Disequilibrium Syndrome, Hemodialysis Disequilibrium Syndrome

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II. Epidemiology

  1. Rare, but potentially lethal

III. Pathophysiology: Dialysis complication

  1. Increased Intracranial Pressure
  2. Rapid decrease in Serum Osmolality during Dialysis

IV. 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

V. 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)

VI. Diagnostics

  1. Electroencephalogram (EEG)
    1. Diffuse metabolic encephalopathy

VII. Imaging

  1. MRI Brain (diffusion weighted)
    1. Osmotic demyelination of pons (and adjacent structures)

VIII. Management

  1. Seizure Prophylaxis
    1. Anticonvulsants
  2. Decrease cerebral edema
    1. Mannitol
    2. Hypertonic Saline

IX. Prevention

  1. Decrease initial Dialysis flow rate and duration (especially if high urea concentration)

X. References

  1. Glauser (2013) Crit Dec Emerg Med 27(10): 2-12
  2. Shaikh (2010) J Emerg Trauma Shock 3(3): 300 [PubMed]

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