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)