A patient undergoing dialysis may develop the Dialysis Disequilibrium Syndrome (DDS).


Mechanism: uncertain; associated with cerebral edema. Osmotically active substances may not be removed as efficiently from the brain as from the blood and these attract water.


Clinical features of DDS:

(1) headache

(2) nausea and/or vomiting

(3) disorientation

(4) visual disturbances, often with papilledema

(5) asterixis

(6) variable confusion

(7) variable lethargy

(8) variable seizures

(9) variable coma

(10) elevated intracranial pressure


Symptoms show a temporal relationship with dialysis. They usually start soon after starting or stopping dialysis, improve with time, then recur with the next dialysis.


Death can occur in the most severe cases, but this is rare today.


To read more or access our algorithms and calculators, please log in or register.