Dysequilibration Syndrome

Dysequilibration syndrome is a complication of dialysis that can occur in dialysis patients as a result of a rapid decrease in plasma osmolality due to a decrease in plasma urea during or after dialysis.

It may accompany the treatment of chronic renal failure , in which nitrogenous metabolites accumulate. Urea, as an inefficient solute, does not participate in concentration gradients under physiological conditions because it is able to cross the plasma membrane of cells freely. The complication is caused by its rapid removal from the plasma, while the passage through the blood-brain barrier is slower. This creates a concentration gradient, which allows water to enter the intracellular compartment, causing symptoms of cerebral edema.

Clinical manifestations

• brain edema
  • unrest
  • headaches
  • confusion
  • nausea, vomiting
  • twitches to cramps
  • alterations of consciousness to unconsciousness

Therapy

The edema itself should be prevented primarily, especially during the first dialysis session. Dialysis should be delayed if mild clinical signs occur. In case of more serious complications, interrupt or increase the plasma osmolality (mannitol).

Links

related articles

• Osmotic demyelinating syndrome

External links

• UpToDate - Dialysis disequilibrium syndrome

Sources

• NEČAS, Emanuel, et al. General pathological physiology. 3rd edition. Praha: Nakladatelství Karolinum, 2009. 377 pp.  ISBN 978-80-246-1688-9 .
• KLENER, Pavel, et al. Internal Medicine. 4th edition. Prague: Galén, 2011. 1174 pp.  ISBN 978-80-7262-705-9 .