How do you treat DDS?
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.
How can we prevent disequilibrium syndrome?
Recognition of patients at high risk, slowing down the efficiency and rate of urea clearance, limiting the decrease in plasma osmolality and avoiding bicarbonate-based rapid correction of metabolic acidosis are strategies for prevention of this syndrome.
What causes DDS?
Dialysis Disequilibrium Syndrome (DDS) is characterized by neurological symptoms caused by rapid removal of urea during hemodialysis. It develops primarily from an osmotic gradient that develops between the brain and the plasma as a result of rapid hemodialysis.
What are the signs and symptoms of disequilibrium syndrome?
Systemic and neurological symptoms are associated with disequilibrium syndrome. Early signs include nausea, headache, vomiting, and restlessness. More serious symptoms can result in seizures and coma. When considering dialysis, review the patient’s serum urea and sodium.
How does disequilibrium syndrome happen?
Etiology: Disequilibrium syndrome commonly occurs in: Elderly and pediatric patients. Patients with pre-existing central nervous system (CNS) lesions (recent stroke, head trauma) or conditions characterized by cerebral edema (malignant hypertension, hyponatremia, hepatic encephalopathy)
What causes dialysis disequilibrium?
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.
Why is mannitol used in dialysis?
Mannitol is used to manage disequilibrium in dialysis patients, as it has a sustained oncotic effect. It increases the osmolarity of the extracellular fluid that results in a fluid shift from the intracellular to the extracellular compartment and causes an increase in plasma volume and pressure.
Can cerebral edema cause death?
A lack of oxygen in the brain can damage brain cells or cause them to die. Intracranial pressure (ICP) can affect specific regions of the brain or the whole brain depending on the underlying cause. Cerebral edema can cause irreversible damage and, in some cases, be fatal.
What are the complications of dialysis?
- Low blood pressure (hypotension). A drop in blood pressure is a common side effect of hemodialysis.
- Muscle cramps. Although the cause is not clear, muscle cramps during hemodialysis are common.
- Sleep problems.
- Bone diseases.
- High blood pressure (hypertension).
- Fluid overload.
What causes tremors after dialysis?
Action myoclonus–renal failure (AMRF) syndrome causes episodes of involuntary muscle jerking or twitching (myoclonus) and, often, kidney (renal) disease.
Is mannitol removed by dialysis?
Mannitol had a half-life of approximately 36 hours during the intervals without treatment. 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).
Can mannitol cause hyperkalemia?
If kidney function is normal, the transient shift of potassium out of cells due to mannitol seldom leads to hyperkalemia.
What are the symptoms of Dialysis disequilibrium syndrome?
Dialysis disequilibrium syndrome (DDS) is a rare syndrome occurring in patients with severe azotemia undergoing their initial HD session. It is characterized by nausea, vomiting, headache, encephalopathy, and seizures ( 7, 8 ). DDS is attributed to the faster decline of urea concentration in the blood than in the brain during the dialysis session.
How to prevent Dialysis disequilibrium in the brain?
Since the dialysis disequilibrium syndrome is primarily the result of osmotic fluid shifts into the brain, avoidance of generation of a significant osmotic gradient between the blood and brain during hemodialysis should prevent the syndrome. This can be achieved using three strategies:
What are the most common side effects of hemodialysis?
Dialysis disequilibrium syndrome (DDS) is an uncommon neurological condition that typically affects people who have just started hemodialysis.
What causes brain swelling in dialysis patients?
This water can then move into brain cells leading it to swell, causing something called cerebral edema. This swelling of the brain cells via this mechanism has been thought of as one of the possible reasons for the usual neurological problems associated with dialysis disequilibrium syndrome.