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Dialysis Disequilibrium Syndrome

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Dialysis Disequilibrium Syndrome, Hemodialysis Disequilibrium Syndrome

  • Epidemiology
  1. Rare, but potentially lethal
  • 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
  • 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]