Overview
Dialysis disequilibrium syndrome (DDS) is characterized by neurological symptoms, particularly in young children undergoing dialysis, often manifesting as seizures, altered mental status, and respiratory abnormalities, likely due to rapid changes in intracranial fluid dynamics 1.Diagnosis
Episodic EEG abnormalities
Sudden respiratory arrest (apneic spells) 1
Altered mental status and seizures
Close temporal association with dialysis sessions
Imaging studies (CT/MRI) may show nonspecific findings or signs of cerebral edema 1Management
Slowing or stopping dialysis to allow for equilibration 1
Supportive care including airway management and monitoring 1
Antiepileptic drugs for seizure control (specific dosing not detailed) 1Special Populations
Pediatrics: Particularly susceptible to DDS due to immature brain-to-skull ratio 1Key Recommendations
Monitor closely for neurological symptoms during and immediately after dialysis sessions (Evidence: Expert opinion) 1
Consider temporary cessation or slowing of dialysis to mitigate symptoms (Evidence: Expert opinion) 1
Implement supportive measures including airway protection and continuous EEG monitoring if available (Evidence: Expert opinion) 1References
1 García-Buñuel L, Elliott DC, Blank NK. Apneic spells in progressive dialysis encephalopathy. Archives of neurology 1980. link