Dialysis disequilibrium syndrome: A preventable fatal acute complication
- Author:
Mah Doo Yee
;
Yia Hua Jern
;
Cheong Wai Seng
- Publication Type:Case Reports
- Keywords:
acute kidney injury;
haemodialysis;
dialysis disequilibrium syndrome;
cerebral oedema
- MeSH:
Dialysis
- From:
The Medical Journal of Malaysia
2016;71(2):91-92
- CountryMalaysia
- Language:English
-
Abstract:
Dialysis disequilibrium syndrome (DDS) is a neurological
disorder with varying severity that is postulated to be
associated with cerebral oedema. We described a case of
DDS resulting in irreversible brain injury and death following
acute haemodialysis. A 13-year-old male with no past
medical history and weighing 30kg, presented to hospital
with severe urosepsis complicated by acute kidney injury
(Creatinine 1422mmol/L; Urea 74.2mmol/L, Potassium
6.3mmol/L, Sodium 137mmol/L) and severe metabolic
acidosis (pH 6.99, HC03 1.7mmol/L). Chest radiograph was
normal. Elective intubation was done for respiratory
distress. Acute haemodialysis performed due to refractory
metabolic acidosis. Following haemodialysis, he became
hypotensive which required inotropes. His Riker's score was
low with absence of brainstem reflexes after withholding
sedation. CT Brain showed generalised cerebral oedema
consistent with global hypoxic changes involving the
brainstem. The symptoms of DDS are caused by water
movement into the brain causing cerebral oedema. Two
theories have been proposed: reverse osmotic shift induced
by urea removal and a fall in cerebral intracellular pH.
Prevention is the key to the management of DDS. It is
important to identify high risk patients and haemodialysis
with reduced dialysis efficacy and gradual urea reduction is
recommended. Patients who are vulnerable to DDS should
be monitored closely. Low efficiency haemodialysis is
recommended. Acute peritoneal dialysis might be an
alternative option, but further studies are needed.
- Full text:P020160628442000945236.pdf
