Intermittent Dialysis Leading to Dialysis Disequilibrium Syndrome

Dialysis disequilibrium syndrome (DDS) is a critical and ultimately fatal condition that presents in hemodialysis patients. Serious manifestations of DDS involve impaired concentration, disorientation, and coma. Risk factors for the condition include dialysis treatment, elevated BUN, renal disease, metabolic acidosis, and pre-existing neurologic disease. There are three main theories proposed to account for the development of DDS, including a reverse urea effect, idiogenic osmoles, and paradoxical brain acidosis. Each of these theories potentiates cerebral edema, and eventually brain herniation, that leads to death. This case examines a 33-year-old Hispanic male brought to the emergency room. He was admitted to the ICU based on hospital findings and had a metabolic acidosis that persisted despite appropriate initial treatment. He was eventually placed on hemodialysis over the course of 2 weeks, and ultimately expired from DDS. This paper aims to demonstrate that hemofiltration is a superior alternative in patients where hemodialysis is indicated, so that DDS, and subsequent fatality, can be avoided. World J Nephrol Urol. 2015;4(3):247-250 doi: http://dx.doi.org/10.14740/wjnu228e