Dialysis disequilibrium syndrome

The hemodialysis disequilibrium (including dialysis disequilibrium syndrome or Erstdialyse syndrome) is a complication occurring during hemodialysis or peritoneal dialysis.

In hemodialysis, the blood will be quickly withdrawn substances (eg urea, NaCl), which include osmotically effective. By lowering the concentration in the blood results in a concentration gradient to the other body compartments, so that by diffusion corresponding substances can pass into the blood and are washed out. A peculiarity among the compartments represents the central nervous system, which is surrounded by the blood -brain barrier and protected from the crossing of toxic metabolites and other endogenous and exogenous neurotoxic substances. At the blood- brain barrier is limited and delayed diffusion instead. If their concentration lowered too quickly at extremely high concentrations of osmotically active substances in the blood, occurs a concentration gradient, which can not be compensated in time by diffusion to blood side of the blood-brain barrier. It is built up an osmotic gradient which causes the concentration is lowered by " thinning " of the brain, ie it is water incorporated and formed a cerebral edema. The results are listed in more detail with symptoms. In severe cases it can lead to coma or even death. The same effect also occurs with excessive alcohol consumption.

In practice, the hemodialysis disequilibrium has become rather rare ( 0.5 % of dialysis patients). Modern dialysis machines ensure this by sensitive monitoring equipment.

Symptoms

• Disorders of consciousness agitation
• Irritability
• Somnolence

• Disease in nephrology