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      Dialysis Disequilibrium Syndrome Induced Seizure Following Hemodialysis

      case-report
      1 , , 1 , 1 , 1 , 2
      ,
      Cureus
      Cureus
      brain edema, chronic kidney insufficiency, dialysis, seizures, urea

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          Abstract

          Dialysis Disequilibrium Syndrome (DDS) is a set of neurological signs and symptoms that can occur during or following dialysis. Osmotic fluid gradient alteration caused by the dialysis process can cause cerebral edema. This process relates to the changes of high gradient urea in both the blood and central nervous system (CNS), which can modulate extracellular fluid influx into brain cells. A 77-year-old woman presented with chronic kidney disease (CKD) and hypertension with headache and tonic-clonic seizure following initial hemodialysis. In this case, we identified that adjustment to the hemodialysis prescriptions such as duration, blood flow rate, and target reduction of blood urea would be the key to avoid seizure following hemodialysis.

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          Most cited references11

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          Dialysis disequilibrium syndrome prevention and management

          Abstract The dialysis disequilibrium syndrome (DDS) is a clinical constellation of neurologic symptoms and signs occurring during or shortly following dialysis, especially when dialysis is first initiated. It is a diagnosis of exclusion occurring in those that are uremic and hyperosmolar, in whom rapid correction with renal replacement therapy leads to cerebral edema and raised intracranial pressure with resultant clinical neurologic manifestations. DDS is most commonly described in association with hemodialysis but can occur in patients with acute kidney injury requiring continuous renal replacement therapy (CRRT). To date, it has not been described in association with peritoneal dialysis. The syndrome is uncommon and becoming rarer, so performing randomized controlled trials to evaluate the effectiveness of potential therapies is almost impossible. This also makes studying the pathophysiology in humans challenging. It is associated with mortality but is also preventable, so identification of patients at risk, preventive measures, early recognition and prompt management of DDS will minimize morbidity and mortality associated with this syndrome. While the focus of this review is the prevention and management of DDS, there will be an emphasis on what is known about the pathophysiology because it strongly impacts the prevention and management strategies.
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            A vanishing complication of haemodialysis: Dialysis disequilibrium syndrome

            Dialysis disequilibrium syndrome (DDS) is a rare syndrome characterised by neurological symptoms related to cerebral oedema. New patients who are started on haemodialysis are at the greatest risk for developing dialysis disequilibrium syndrome. Classical DDS develops during or immediately after haemodialysis. It is a generally self-limiting condition and settles with supportive management. Our case report describes DDS in a patient on chronic haemodialysis. She developed a tonic-clonic seizure shortly after completing 4 h of haemodialysis. This occurred in the context of having missed one session of dialysis, but with no new changes made to her usual dialysis regime. She was managed supportively in the intensive care unit and made a full recovery.
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              Epilepsy and anti-seizure medications increase all-cause mortalityin dialysis patients in the United States.

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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                8 September 2021
                September 2021
                : 13
                : 9
                : e17821
                Affiliations
                [1 ] Department of Neurology, Wangaya General Hospital, Bali, IDN
                [2 ] Department of Neurology, Arifin Achmad General Hospital, Riau, IDN
                Author notes
                Article
                10.7759/cureus.17821
                8500255
                34660031
                10e8472c-81ea-4bb6-9b45-96636dbac283
                Copyright © 2021, Wirawan et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 8 September 2021
                Categories
                Internal Medicine
                Neurology

                brain edema,chronic kidney insufficiency,dialysis,seizures,urea

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