Dialysis disequilibrium syndrome: Difference between revisions
(Expanded differential, workup and management sections, minor additions and formatting changes to background and clinical features, added references) |
No edit summary |
||
Line 3: | Line 3: | ||
**Occurs most commonly during initial hemodialysis or during hypercatabolic states | **Occurs most commonly during initial hemodialysis or during hypercatabolic states | ||
*Large and rapid solute clearance creates an osmotic gradient which can precipitate cerebral edema <ref>Silver SM. et al. Dialysis disequilibrium syndrome (DDS) in the rat: role of the "reverse urea effect". Kidney Int. 1992;42(1):161-6. [http://www.ncbi.nlm.nih.gov/pubmed?term=1635345 Pubmed]</ref> | *Large and rapid solute clearance creates an osmotic gradient which can precipitate cerebral edema <ref>Silver SM. et al. Dialysis disequilibrium syndrome (DDS) in the rat: role of the "reverse urea effect". Kidney Int. 1992;42(1):161-6. [http://www.ncbi.nlm.nih.gov/pubmed?term=1635345 Pubmed]</ref> | ||
**Pre-dialysis urea in CSF lower than in blood<ref>Zepeda-Orozco D and Quigley R. Dialysis disequilibrium syndrome. Pediatr Nephrol. 2012 Dec; 27(12): 2205–2211.</ref> | |||
**Post-dialysis urea in CSF higher, setting up osmotic gradient for water into CNS | |||
**More uremic patients at higher risk post-dialysis | |||
==Clinical Features== | ==Clinical Features== |
Revision as of 02:04, 20 August 2016
Background
- Dialysis Disequilibrium Syndrome (DDS) is a rare clinical syndrome occurring at end of dialysis or the beginning of continuous renal replacement therapy
- Occurs most commonly during initial hemodialysis or during hypercatabolic states
- Large and rapid solute clearance creates an osmotic gradient which can precipitate cerebral edema [1]
- Pre-dialysis urea in CSF lower than in blood[2]
- Post-dialysis urea in CSF higher, setting up osmotic gradient for water into CNS
- More uremic patients at higher risk post-dialysis
Clinical Features
- Headache
- Disorientation
- Nausea and vomiting
- Restlessness
- Can progress to seizure, coma & death [3]
Differential Diagnosis
- Subdural hematoma
- Uremia
- Nonketotic hyperosmolar coma
- Acute cerebrovascular event
- Dialysis dementia
- Excessive ultrafiltration and seizure
- Metabolic disturbances
- Meningitis
- Malignant hypertension[3][4]
Dialysis Complications
- Dialysis-associated hypotension
- Dialysis disequilibrium syndrome
- Air embolism
- Missed dialysis (pulmonary edema)
Workup
- Diagnosis suggested by development of neurologic symptoms associated with dialysis, however DDS is a diagnosis of exclusion (rule out SDH, CVA).
Management
Prevention
- Response to treatment is typically poor, so preventive measures are important[3]
- Add an osmotic agent to mitigate the osmotic gradient
- Consider hemofiltration rather than hemodialysis[7]
Treatment
- The mainstay of treatment is ICP reduction[3]
- Can give mannitol or hypertonic saline IV
- Can hyperventilate patient
- Symptomatic management for mild symptoms (nausea, headache, restlessness)
- Symptoms are self-limiting and typically resolve within several hours
See Also
References
- ↑ Silver SM. et al. Dialysis disequilibrium syndrome (DDS) in the rat: role of the "reverse urea effect". Kidney Int. 1992;42(1):161-6. Pubmed
- ↑ Zepeda-Orozco D and Quigley R. Dialysis disequilibrium syndrome. Pediatr Nephrol. 2012 Dec; 27(12): 2205–2211.
- ↑ 3.0 3.1 3.2 3.3 Zepeda-orozco D. et al. Dialysis disequilibrium syndrome. Pediatr Nephrol. 2012;27(12):2205-11.Pubmed
- ↑ Mahoney CA. et al. Uremic encephalopathies: clinical, biochemical, and experimental features. Am J Kidney Dis. 1982;2(3):324-36. Pubmed
- ↑ Port FK. et al. Prevention of dialysis disequilibrium syndrome by use of high sodium concentration in the dialysate. Kidney Int. 1973;3(5):327-33.Pubmed
- ↑ Rodrigo F. et al. Osmolality changes during hemodialysis. Natural history, clinical correlations, and influence of dialysate glucose and intravenous mannitol. Ann Intern Med. 1977;86(5):554-61. Pubmed
- ↑ Kishimoto T. et al. Superiority of hemofiltration to hemodialysis for treatment of chronic renal failure: comparative studies between hemofiltration and hemodialysis on dialysis disequilibrium syndrome. Artif Organs. 1980;4(2):86-93. Pubmed