Dialysis Disequilibrium Syndrome: Rare Serious Complication of Hemodialysis and Effective Management.

Sreedhar Adapa,Vijay Gayam,Narothama Reddy Aeddula,Venu Madhav Konala,Srikanth Naramala

doi:10.7759/cureus.5000

Sreedhar Adapa, Vijay Gayam + Show 3 more

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https://doi.org/10.7759/cureus.5000

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Journal: Cureus	Publication Date: Jun 25, 2019
Citations: 6	License type: cc-by

Affiliation: Deaconess Hospital, Indiana University

Abstract

Dialysis disequilibrium syndrome (DDS) is an extremely rare central nervous system complication that occurs in patients receiving hemodialysis and can be potentially fatal. The prognosis is poor when this manifests with serious neurological manifestations like seizures and obtundation. Evidence in effective management is sparse. Herein, we present the case of a patient who developed seizures and altered mental status during hemodialysis. The patient successfully recovered with the administration of mannitol and 3% hypertonic saline without any long-term neurologic sequelae.

Highlights

Dialysis disequilibrium syndrome (DDS) is an extremely rare central nervous system complication that occurs in patients receiving hemodialysis and can be potentially fatal
Dialysis disequilibrium syndrome (DDS) is the clinical condition of acute neurologic deterioration attributed to dialysis treatment
Vitals at presentation were temperature 96 °F, heart rate 53 beats per min, respiratory rate 24 per min, blood pressure 88/60 mm of Hg, and pulse oximetry 93% on 6L nasal canula. He was hyperkalemic and bradycardic, and emergent hemodialysis was arranged with the central venous catheter (CVC) after medical management

Summary

Introduction

Dialysis disequilibrium syndrome (DDS) is the clinical condition of acute neurologic deterioration attributed to dialysis treatment. DDS is a serious complication that occurs during or immediately after aggressive initial hemodialysis but can develop in patients undergoing chronic dialysis. This phenomenon was first reported in 1962, but DDS with severe neurological symptoms such as mental status changes, seizures, and coma are rarely encountered in current clinic practice [1]. Postdialysis labs revealed BUN 64 mg/dl (urea reduction ratio [URR] 54.6%), creatinine 5.2 mg/dl, and potassium 3.2 mmol/L He had to be dialyzed again the following day for hyperkalemia (5.7 mmol/L) and fluid overload state.

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