Dialysis disequilibrium syndrome (DDS) is a condition that arises following hemodialysis, typically in patients undergoing hemodialysis for the first time or in patients with risk factors including elevated blood urea nitrogen prior to hemodialysis, chronic kidney disease, severe metabolic acidosis, and other disorders that cause cerebral edema or increase the permeability of the blood-brain barrier. It is more common in older adults and children.
DDS occurs due to osmotic shifts and rapid lowering of urea and plasma osmolality, resulting in the development of cerebral edema following hemodialysis. Patients present with symptoms including headache, nausea, vomiting, muscle cramps, tremor, confusion, and convulsions. Symptoms typically present during or immediately following hemodialysis or early in the course of continuous renal replacement therapy. DDS has not been described with continuous peritoneal dialysis.
Treatment involves slowing the blood flow rate of dialysis or cessation of dialysis in severe cases.
Dialysis disequilibrium syndrome
Alerts and Notices
Important News & Links
Synopsis
Codes
ICD10CM:
E87.8 – Other disorders of electrolyte and fluid balance, not elsewhere classified
SNOMEDCT:
87235005 – Dialysis disequilibrium syndrome
E87.8 – Other disorders of electrolyte and fluid balance, not elsewhere classified
SNOMEDCT:
87235005 – Dialysis disequilibrium syndrome
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
Differential Diagnosis & Pitfalls
To perform a comparison, select diagnoses from the classic differential
Subscription Required
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
References
Subscription Required
Last Reviewed:02/10/2019
Last Updated:02/10/2019
Last Updated:02/10/2019
Dialysis disequilibrium syndrome