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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)