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Dialysis Disequilibrium Syndrome


Presentation

  • We present the case of a young adult with severe uremia who, despite application of recommended measures, developed DDS and non-cardiogenic pulmonary edema.[ncbi.nlm.nih.gov]
  • PowerPoint Presentation Last modified by: PowerPoint PPT presentation free to download Chronic Renal Failure, Proteinuria, Hematuria Jeffrey T.[powershow.com]
  • A 38-year-old woman with type 1 diabetes mellitus presented with decreased visual acuity and bilateral optic nerve swelling associated with systemic signs and symptoms of dialysis disequilibrium syndrome.[doi.org]
Splenectomy
  • He underwent splenectomy and Hartman's procedure; hemostasis was achieved by packing the abdominal cavity. He was transferred to the trauma intensive care unit (TICU) for further management.[onlinejets.org]
Productive Cough
  • Case presentation A 22-year-old homosexual male presented to hospital with progressive dyspnea, productive cough, generalized malaise and fever.[doi.org]
Refractory Shock
  • The patient rapidly progressed to refractory shock and multi-organ dysfunction Diagnosis of brain death was declared independently by an intensivist and a neurologist. At autopsy, the brain showed evidence of diffuse cerebral edema.[doi.org]
Uremic Frost
  • It includes clinical manifestations such as calciphylaxis and uremic frost, which are now rarely seen.[ncbi.nlm.nih.gov]
Confusion
  • Clinical features of DDS: (1) headache (2) nausea and/or vomiting (3) disorientation (4) visual disturbances, often with papilledema (5) asterixis (6) variable confusion (7) variable lethargy (8) variable seizures (9) variable coma (10) elevated intracranial[meducator3.net]
  • […] disequilibrium syndrome usually occurs during the patient’s first few dialysis sessions. 3 The symptoms of the syndrome include: 3 irritability restlessness headache nausea emesis hypertension blurred vision seizures muscular twitching fasciculations asterixis confusion[epilepsy.com]
  • Some healthcare professionals believe that the symptoms patients sometimes experience including restlessness, headache, coma, confusion, or even death are the result of a slowing of the transport of urea out of cells in the brain.[dialysistechniciansalary.org]
  • Here is a non-inclusive list of symptoms : Nausea Headache Disorientation Confusion Cramps Dizziness Seizures Coma, or death in severe cases Causes You would think that with dialysis being around for half a century, we would understand all its adverse[verywell.com]
  • One hour after the end of the first session of HD, which lasted for 2.5 h, with an arterial blood flow of 250 mL/min, she started to develop new-onset headaches, confusion and disorientation to person and time.[sjkdt.org]
Papilledema
  • The purpose of this paper is to report a case of dialysis disequilibrium syndrome as an unusual cause of papilledema.[doi.org]
  • "Papilledema associated with dialysis disequilibrium syndrome". Semin Ophthalmol. 22 (3): 133–5. doi : 10.1080/08820530701421585. PMID 17763231. Chen CL, Lai PH, Chou KJ, Lee PT, Chung HM, Fang HC (2007).[en.wikipedia.org]
  • Papilledema associated with dialysis dissociation syndrome. Seminars Ophthalmology. 2007; 22: 133-135.[meducator3.net]
Focal Neurologic Deficit
  • Cerebral edema was thus attributed to osmotic effects related to a high urea gradient between plasma and brain. [3] Diagnosis [ edit ] Clinical signs of cerebral edema, such as focal neurological deficits, papilledema [4] and decreased level of consciousness[en.wikipedia.org]
  • Cerebral edema was thus attributed to osmotic effects related to a high urea gradient between plasma and brain. [3] Diagnosis Clinical signs of cerebral edema, such as focal neurological deficits, papilledema [4] and decreased level of consciousness,[ipfs.io]
  • Dialysis disequilibrium syndrome presenting as a focal neurological deficit. Hemodial Int 2008;12:313-315. 54. Patel N, Dalal P, Panesar M. Dialysis disequilibrium syndrome: A narrative review. Semin Dial 2008;21:493-498. 55.[ahcmedia.com]
Decerebrate Posturing
  • In the emergency department, the patient was unresponsive, intubated, with decerebrate posturing and intact brainstem reflexes.[neurology.org]

Workup

  • Further workup did not reveal any clear toxic, cerebrovascular or metabolic cause. I’m not sure what role dialysis played in the seizure but we did do our best to try and minimize the risk of DDS.[renalfellow.blogspot.com]
  • Following septic workup, his antibiotic management was changed to meropenem.[onlinejets.org]
Pyuria
  • Urinalysis showed pyuria. Electrocardiogram (ECG) showed normal sinus rhythm. Table 1 Laboratory values at prior to and following initiation of hemodialysis in the intensive care unit.[doi.org]
Urea Increased
  • At day 11, urea increased to 35.6 mmol/L and creatininemia to 452 μmol/L. Serum sodium was 145 mmol/L. Because the trauma had occurred several days before, we decided to perform HD. One hour after the start of HD, an ICH appeared (ICP 37 mm Hg).[ccforum.biomedcentral.com]
Hypercapnia
  • Intracranial hypertension at 12:30 p.m. was due to hypotension after increased neurosedation and at 1:30 p.m. was due to hypercapnia (50 mm Hg) after a change of ventilation mode (from assisted spontaneous breathing to synchronized controlled mechanical[ccforum.biomedcentral.com]
White Matter Lesions
  • Her transient cerebral white matter lesions were thought to be interstitial edema derived from dialysis disequilibrium syndrome (DDS), which might have been amplified by subclinical brain injury due to past chemotherapy.[ncbi.nlm.nih.gov]

Treatment

  • MRI of the head has been used in research to better understand DDS. [5] Treatment [ edit ] Avoidance is the primary treatment. Better alternatives are Nocturnal or Daily Dialysis, which are far more gentle processes for the new dialysis patient.[en.wikipedia.org]
  • Although it has been reported in patients receiving chronic HD, DDS is more common during or immediately after the first HD treatment. The exact incidence of DDS is unknown.[ncbi.nlm.nih.gov]
  • Qb and treatment time can be increased in a step wise manner over the next 3-4 daily treatments. This is incorrect. Try again.[hemodialysiskinetics.coursepress.yale.edu]
  • The blood purifying treatment for their chronic kidney disease is already pretty aggressive, and it gets even tougher when this treatment gets unexpected complications.[joecosgrovepentechealth.wordpress.com]

Prognosis

  • Hence, either elevated ICP and/or shock may lead to poor CPP and worsened prognosis.[jmedscindmc.com]
  • Overall prognosis is good, with rapid recovery after treatment of the rejection episode. The presumed pathology is cytokine production secondary to the rejection process. Uremic polyneuropathy is the most common neurologic complication of RF.[emedicine.medscape.com]

Etiology

  • Etiology The cause of DDS is currently not well understood.[ipfs.io]
  • Elderly and pediatric patients Patients with pre-existing CNS lesions (recent stroke, head trauma) or conditions characterized by cerebral edema (malignant hypertension, hyponatremia, hepatic encephalopathy) High pre-dialysis BUN Severe metabolic acidosis Etiology[advancedrenaleducation.com]
  • […] radiological resolution occur within days to a few weeks if prompt diagnosis is made and treatment is given early. [7], [8] We report here a patient with PRES secondary to dialysis DDS in whom blood pressure was not elevated and in whom all other possible etiologies[sjkdt.org]
  • […] are as follows 4 Uremia Dialysis dementia Hypoglycemia Acute cerebrovascular event Nonketotic hyperosmolar coma Excessive ultrafiltration and seizure Hyponatremia Malignant hypertension Subdural hematoma Disequilibrium Syndrome In Dialysis The exact etiology[syndromespedia.com]

Epidemiology

  • In summary, the precise epidemiology and pathophysiology of DDS remain unclear.[doi.org]
  • ., 24(9):2915–2919 Google Scholar Parfrey PS, Foley RN (1999) The clinical epidemiology of cardiac disease in chronic renal failure.[link.springer.com]
  • Epidemiology The number of patients with ESRD and on dialysis has been steadily increasing. In 2009, there were 370,274 patients on HD and 27,522 patients on PD in the United States.[ahcmedia.com]
Sex distribution
Age distribution

Pathophysiology

  • Using a case study, this article discusses the pathophysiology, clinical manifestations, prevention, and management of dialysis disequilibrium syndrome.[ncbi.nlm.nih.gov]
  • In this review, we will examine the pathophysiology of this syndrome and discuss the factors to consider in avoiding its development.[utsouthwestern.influuent.utsystem.edu]

Prevention

  • Using a case study, this article discusses the pathophysiology, clinical manifestations, prevention, and management of dialysis disequilibrium syndrome.[ncbi.nlm.nih.gov]
  • Experimental dialysis disequilibrium syndrome: prevention with glycerol. Kidney Int. 1978 Sep; 14 (3):270–278. [ PubMed ] [ Google Scholar ] Port FK, Johnson WJ, Klass DW.[pubmedcentral.nih.gov]

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