In this section
Acute haemodialysis is associated with this syndrome due to the
reduction of plasma solute level over a limited time. Plasma
becomes hypotonic compared to brain cells and water shifts from the
plasma into the brain tissue
Systemic and neurological symptoms are associated with
Early signs include nausea, headache, vomiting, and
restlessness. More serious symptoms can result in seizures
When considering dialysis, review the patient's serum urea and
A hypernatremic and excessively uremic patient is at high risk
for developing dialysis disequlibrium syndrome, as such it may be
difficult to correct plasma sodium and urea
Plan to dialyse at a reduced blood flow rate for short
Consider the use of Mannitol (1gm/kg) over the first hour.
If the symptoms of disequilibrium syndrome occur during dialysis
reduce the blood flow rate to decrease the efficiency of solute
Consider administering hypertonic solutions.
Implement supportive measures where appropriate for a severe
Prophylactic infusion of Mannitol 20% at 1g/kg is suggested for
initial dialysis session.
This is given over the first hour of dialysis.
In second and subsequent dialysis sessions, prophylactic
infusion of Mannitol can be given at 0.5-1g/kg.