UMEM Educational Pearls

Category: Critical Care

Title: Dialysis disequilibrium syndrome

Keywords: dialysis disequilibrium syndrome, mannitol, cerebral edema (PubMed Search)

Posted: 4/1/2008 by Mike Winters, MD (Updated: 2/24/2020)
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Dialysis Disequilibrium Syndrome (DDS)

  • Although typically seen in ESRD patients who are being initiated on hemodialysis, DDS can be seen in the critically ill
  • Critically ill patients at risk for DDS include recent CVA, head trauma, subdural hematoma, hyponatremia,hypertensive emergency, and hepatic encephalopathy
  • Mild cases are characterized by restlessness, nausea, vomiting, headache, disorientation, and tremors
  • More severe symptoms include seizures and coma
  • The exact pathogenesis is debated but centers around acute cerebral edema
  • Treatment of DDS primarily centers around manipulation of hemodialysis
  • For the EP: patients with DDS presenting with seizures can be treated by rapidly increasing plasma osmolality with either hypertonic saline or mannitol (12.5 gms)