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Dialysis disequilibrium syndrome and other treatment complications of extreme uremia: a rare occurrence yet not vanished.
Hemodial Int. 2008 Jul; 12(3):301-6.HI

Abstract

Severe uremia is now a rare occurrence in most developed nations, and yet is still present in many countries of the world. It includes clinical manifestations such as calciphylaxis and uremic frost, which are now rarely seen. Patients with extremely high levels of blood urea nitrogen (above 175 mg/dL) are at a higher risk of experiencing first-time hemodialysis-related complications, in particular dialysis disequilibrium syndrome (DDS). DDS is a central nervous disorder characterized by a wide variety of neurological symptoms that range from nausea and vomiting to even death due to cerebral edema. There are 2 main theories to explain its pathophysiology: the reverse urea effect, which considers that the shift of urea between brain intracellular space and plasma is not immediate, causing a higher concentration of urea within the brain and leading to cerebral edema. The second theory considers that after hemodialysis, patients have transient paradoxical metabolic acidosis within the central nervous system, displacing Na(+) and K(+) from organic anions, making them osmotically active and again leading to cerebral edema. The main goal is to prevent the occurrence of DDS, for which there are several proposed measures including continuous renal replacement therapies. Once established, treatment should be focused on supportive therapy. Another uncommon phenomenon described in patients who initiate hemodialysis is transient pulmonary leukocyte margination, which in conjunction with an inflammatory milieu, may lead to non-cardiogenic pulmonary edema. We present the case of a young adult with severe uremia who, despite application of recommended measures, developed DDS and non-cardiogenic pulmonary edema.

Authors+Show Affiliations

National Medical Science and Nutrition, National Autonomous University of Mexico, Mexico City, Mexico.No affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

18638082

Citation

Lopez-Almaraz, Ernesto, and Ricardo Correa-Rotter. "Dialysis Disequilibrium Syndrome and Other Treatment Complications of Extreme Uremia: a Rare Occurrence yet Not Vanished." Hemodialysis International. International Symposium On Home Hemodialysis, vol. 12, no. 3, 2008, pp. 301-6.
Lopez-Almaraz E, Correa-Rotter R. Dialysis disequilibrium syndrome and other treatment complications of extreme uremia: a rare occurrence yet not vanished. Hemodial Int. 2008;12(3):301-6.
Lopez-Almaraz, E., & Correa-Rotter, R. (2008). Dialysis disequilibrium syndrome and other treatment complications of extreme uremia: a rare occurrence yet not vanished. Hemodialysis International. International Symposium On Home Hemodialysis, 12(3), 301-6. https://doi.org/10.1111/j.1542-4758.2008.00270.x
Lopez-Almaraz E, Correa-Rotter R. Dialysis Disequilibrium Syndrome and Other Treatment Complications of Extreme Uremia: a Rare Occurrence yet Not Vanished. Hemodial Int. 2008;12(3):301-6. PubMed PMID: 18638082.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dialysis disequilibrium syndrome and other treatment complications of extreme uremia: a rare occurrence yet not vanished. AU - Lopez-Almaraz,Ernesto, AU - Correa-Rotter,Ricardo, PY - 2008/7/22/pubmed PY - 2008/11/15/medline PY - 2008/7/22/entrez SP - 301 EP - 6 JF - Hemodialysis international. International Symposium on Home Hemodialysis JO - Hemodial Int VL - 12 IS - 3 N2 - Severe uremia is now a rare occurrence in most developed nations, and yet is still present in many countries of the world. It includes clinical manifestations such as calciphylaxis and uremic frost, which are now rarely seen. Patients with extremely high levels of blood urea nitrogen (above 175 mg/dL) are at a higher risk of experiencing first-time hemodialysis-related complications, in particular dialysis disequilibrium syndrome (DDS). DDS is a central nervous disorder characterized by a wide variety of neurological symptoms that range from nausea and vomiting to even death due to cerebral edema. There are 2 main theories to explain its pathophysiology: the reverse urea effect, which considers that the shift of urea between brain intracellular space and plasma is not immediate, causing a higher concentration of urea within the brain and leading to cerebral edema. The second theory considers that after hemodialysis, patients have transient paradoxical metabolic acidosis within the central nervous system, displacing Na(+) and K(+) from organic anions, making them osmotically active and again leading to cerebral edema. The main goal is to prevent the occurrence of DDS, for which there are several proposed measures including continuous renal replacement therapies. Once established, treatment should be focused on supportive therapy. Another uncommon phenomenon described in patients who initiate hemodialysis is transient pulmonary leukocyte margination, which in conjunction with an inflammatory milieu, may lead to non-cardiogenic pulmonary edema. We present the case of a young adult with severe uremia who, despite application of recommended measures, developed DDS and non-cardiogenic pulmonary edema. SN - 1492-7535 UR - https://www.unboundmedicine.com/medline/citation/18638082/Dialysis_disequilibrium_syndrome_and_other_treatment_complications_of_extreme_uremia:_a_rare_occurrence_yet_not_vanished_ L2 - https://doi.org/10.1111/j.1542-4758.2008.00270.x DB - PRIME DP - Unbound Medicine ER -