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Dialysis Disequilibrium Syndrome: brain death following hemodialysis for metabolic acidosis and acute renal failure--a case report.
BMC Nephrol. 2004 Aug 19; 5:9.BN

Abstract

BACKGROUND

Dialysis disequilibrium syndrome (DDS) is the clinical phenomenon of acute neurologic symptoms attributed to cerebral edema that occurs during or following intermittent hemodialysis (HD). We describe a case of DDS-induced cerebral edema that resulted in irreversible brain injury and death following acute HD and review the relevant literature of the association of DDS and HD.

CASE PRESENTATION

A 22-year-old male with obstructive uropathy presented to hospital with severe sepsis syndrome secondary to pneumonia. Laboratory investigations included a pH of 6.95, PaCO2 10 mmHg, HCO3 2 mmol/L, serum sodium 132 mmol/L, serum osmolality 330 mosmol/kg, and urea 130 mg/dL (46.7 mmol/L). Diagnostic imaging demonstrated multifocal pneumonia, bilateral hydronephrosis and bladder wall thickening. During HD the patient became progressively obtunded. Repeat laboratory investigations showed pH 7.36, HCO3 19 mmol/L, potassium 1.8 mmol/L, and urea 38.4 mg/dL (13.7 mmol/L) (urea-reduction-ratio 71%). Following HD, spontaneous movements were absent with no pupillary or brainstem reflexes. Head CT-scan showed diffuse cerebral edema with effacement of basal cisterns and generalized loss of gray-white differentiation. Brain death was declared.

CONCLUSIONS

Death is a rare consequence of DDS in adults following HD. Several features may have predisposed this patient to DDS including: central nervous system adaptations from chronic kidney disease with efficient serum urea removal and correction of serum hyperosmolality; severe cerebral intracellular acidosis; relative hypercapnea; and post-HD hemodynamic instability with compounded cerebral ischemia.

Authors+Show Affiliations

Department of Critical Care Medicine, Calgary Health Region, University of Calgary, Calgary, Alberta, Canada. smbagsha@ucalgary.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

15318947

Citation

Bagshaw, Sean M., et al. "Dialysis Disequilibrium Syndrome: Brain Death Following Hemodialysis for Metabolic Acidosis and Acute Renal Failure--a Case Report." BMC Nephrology, vol. 5, 2004, p. 9.
Bagshaw SM, Peets AD, Hameed M, et al. Dialysis Disequilibrium Syndrome: brain death following hemodialysis for metabolic acidosis and acute renal failure--a case report. BMC Nephrol. 2004;5:9.
Bagshaw, S. M., Peets, A. D., Hameed, M., Boiteau, P. J., Laupland, K. B., & Doig, C. J. (2004). Dialysis Disequilibrium Syndrome: brain death following hemodialysis for metabolic acidosis and acute renal failure--a case report. BMC Nephrology, 5, 9.
Bagshaw SM, et al. Dialysis Disequilibrium Syndrome: Brain Death Following Hemodialysis for Metabolic Acidosis and Acute Renal Failure--a Case Report. BMC Nephrol. 2004 Aug 19;5:9. PubMed PMID: 15318947.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dialysis Disequilibrium Syndrome: brain death following hemodialysis for metabolic acidosis and acute renal failure--a case report. AU - Bagshaw,Sean M, AU - Peets,Adam D, AU - Hameed,Morad, AU - Boiteau,Paul J E, AU - Laupland,Kevin B, AU - Doig,Christopher J, Y1 - 2004/08/19/ PY - 2004/05/21/received PY - 2004/08/19/accepted PY - 2004/8/21/pubmed PY - 2005/3/19/medline PY - 2004/8/21/entrez SP - 9 EP - 9 JF - BMC nephrology JO - BMC Nephrol VL - 5 N2 - BACKGROUND: Dialysis disequilibrium syndrome (DDS) is the clinical phenomenon of acute neurologic symptoms attributed to cerebral edema that occurs during or following intermittent hemodialysis (HD). We describe a case of DDS-induced cerebral edema that resulted in irreversible brain injury and death following acute HD and review the relevant literature of the association of DDS and HD. CASE PRESENTATION: A 22-year-old male with obstructive uropathy presented to hospital with severe sepsis syndrome secondary to pneumonia. Laboratory investigations included a pH of 6.95, PaCO2 10 mmHg, HCO3 2 mmol/L, serum sodium 132 mmol/L, serum osmolality 330 mosmol/kg, and urea 130 mg/dL (46.7 mmol/L). Diagnostic imaging demonstrated multifocal pneumonia, bilateral hydronephrosis and bladder wall thickening. During HD the patient became progressively obtunded. Repeat laboratory investigations showed pH 7.36, HCO3 19 mmol/L, potassium 1.8 mmol/L, and urea 38.4 mg/dL (13.7 mmol/L) (urea-reduction-ratio 71%). Following HD, spontaneous movements were absent with no pupillary or brainstem reflexes. Head CT-scan showed diffuse cerebral edema with effacement of basal cisterns and generalized loss of gray-white differentiation. Brain death was declared. CONCLUSIONS: Death is a rare consequence of DDS in adults following HD. Several features may have predisposed this patient to DDS including: central nervous system adaptations from chronic kidney disease with efficient serum urea removal and correction of serum hyperosmolality; severe cerebral intracellular acidosis; relative hypercapnea; and post-HD hemodynamic instability with compounded cerebral ischemia. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/15318947/Dialysis_Disequilibrium_Syndrome:_brain_death_following_hemodialysis_for_metabolic_acidosis_and_acute_renal_failure__a_case_report_ L2 - https://www.biomedcentral.com/1471-2369/5/9 DB - PRIME DP - Unbound Medicine ER -