Het dialyse-disequilibriumsyndroom: casusbespreking en literatuuroverzicht

Abstract

Dialysis disequilibrium syndrome: a case report and review of the literature The dialysis disequilibrium syndrome (DDS) is a preventable, but potentially life-threatening complication of hemodialysis. Its incidence is low since the application of preventive measures, but its importance is not to be overlooked. The objective of this case report is to emphasize the importance of the prevention of DDS and to give an overview of the literature with a specific focus on prevention. A 62-year-old female patient presented to the emergency department with acute postrenal kidney injury due to a cervix carcinoma with invasion and obstruction of both ureters. Hemodialysis was deemed necessary because of hyperkalemia. By the end of this procedure, the patient suffered from severe neurological deterioration with stupor and myoclonus. She was urgently intubated, sedated and mechanically ventilated. The CT scan of the brain showed cerebral edema. DDS was suspected. The neurological symptoms improved during the following day. Bilateral nephrostomy catheters were placed, upon which the kidney injury resolved. This case report highlights the importance of risk stratification of patients at risk for DDS. In these patients, preventive measures are recommended, such as low-efficiency dialysis or treatment with osmotically active agents.