How do you manage dialysis disequilibrium syndrome?
Treatment of the dialysis disequilibrium syndrome The treatment of disequilibrium after it has developed is aimed at reducing the intracranial pressure of the patient. Standard maneuvers are to give mannitol or hypertonic saline to raise the blood osmolality and to hyperventilate the patient.
What happens in dialysis disequilibrium syndrome?
It develops primarily from an osmotic gradient that develops between the brain and the plasma as a result of rapid hemodialysis. This results in brain edema that manifests as neurological symptoms such as headache, nausea, vomiting, muscle cramps, tremors, disturbed consciousness, and convulsions.
Why does dialysis disequilibrium syndrome occur?
Dialysis disequilibrium syndrome refers to a range of symptoms that may occur during dialysis, especially in patients in whom dialysis is initially started or who have missed frequent sessions of dialysis. It is believed to occur due to the rapid clearance of substances such as urea that get accumulated in the blood.
What are the signs and symptoms of disequilibrium syndrome?
Disequilibrium syndrome (DDS) is a rare but serious complication of hemodialysis. It is characterized mainly by neurological symptoms such as fatigue, mild headaches, nausea, vomiting, disturbed consciousness, convulsions and coma. The symptoms are usually mild, transient and self-limiting and rarely, it can be fatal.
How is mannitol cleared?
The ideal treatment is hemodialysis that rapidly removes mannitol (half-life, six hours) and replaces it with sodium; peritoneal dialysis removed mannitol slowly (half-life, 21 hours).
Why is mannitol contraindicated in renal failure?
Mannitol therapy should be discontinued if progression in renal damage or dysfunction, heart failure, or pulmonary congestion occurs. A test dose should be administered in patients with severe renal impairment. Diuresis caused by mannitol administration may exacerbate electrolyte imbalances.
What is the Dialysis disequilibrium syndrome?
The dialysis disequilibrium syndrome (DDS) is a clinical constellation of neurologic symptoms and signs occurring during or shortly following dialysis, especially when dialysis is first initiated.
How can the disequilibrium syndrome be prevented?
Since the principle factor leading to the disequilibrium syndrome is the development of an osmotic gradient causing water to move into the brain, preventing the development of this gradient should prevent the syndrome. The simplest way to do this is to perform hemofiltration on the patient instead of dialysis [28].
What causes diastolic dyskinesia in dialysis patients?
Classically, DDS arises in individuals starting hemodialysis due to end-stage chronic kidney disease and is associated, in particular, with “aggressive” (high solute removal) dialysis. However, it may also arise in fast onset, i.e. acute kidney failure in certain conditions. The cause of DDS is currently not well understood.
What are the signs and symptoms of maintenance hemodialysis?
Despite the fact that maintenance hemodialysis has been a routine procedure for over 50 years, this syndrome remains poorly understood. The signs and symptoms vary widely from restlessness and headache to coma and death.
