Disequilibrium syndrome is a disorder that occurs in patients undergoing hemodialysis for end stage renal disease. It is also known as dialysis disequilibrium syndrome. This condition is serious neurological complication arising from hemodialysis. The underlying pathology of disequilibrium syndrome is cerebral edema and increased intracranial pressure during or after hemodialysis. The syndrome was first recognized in 1962 and symptoms include severe headache, restlessness, vomiting and nausea, twitching of muscles, disorientation, tremors and rarely seizures. Children and young patients on dialysis are affected more than adults. Usually the symptoms wane off after some time but in severe cases hemodialysis must be stopped.
Causes of Disequilibrium Syndrome
Dialysis disequilibrium syndrome is a serious neurological and systemic manifestation occurring as a result of aggressive hemodialysis in patients suffering from end stage renal disease. The syndrome can occur during or soon after dialysis procedure. Patients undergoing dialysis for first time are more predisposed to this disorder. Although it can develop in anyone undergoing dialytic procedure, it is more common in pediatric age group and elderly undergoing the therapy. Patients having pre-existing neurological lesion as in case of stroke, head injury, seizures are more prone to it, when they are undergoing hemodialysis.
Disequilibrium Syndrome Symptoms
Dialysis disequilibrium syndrome was first described in 1962. It is thought to occur due to rapid flux of urea from the blood with slower excretion from the cerebro spinal fluid because of blood- brain barrier mechanism. This will lead to features of cerebral edema (brain swelling). Usually people with chronic kidney failure who are undergoing hemodialysis for the first time are at greater risk of disequilibrium syndrome. Especially the symptoms develop when the procedure is done aggressively with faster removal of urea. Symptoms occur during or soon after dialysis. Following are the symptoms:
- Severe headache
- Increased restlessness
- Nausea
- Vomiting
- Elevated blood pressure
- Muscle cramps
- Disorientation
- Blurred vision
- Dizziness
- Less alertness
- Confusion
- Seizure
- Coma
Treatment of Disequilibrium Syndrome
The symptoms of dialysis disequilibrium syndrome have become less severe in last few decades because of improved management of patients with renal failure undergoing hemodialysis. With newer techniques of dialysis the incidence of dialysis disequilibrium syndrome is substantially reduced. However, if the symptoms are severe, dialysis is stopped. In case of seizure medications to control seizure is administered. Nowadays in first few session dialysis is done slowly and for short period of time if the patient is having very high urea level. Even prophylactic medicines to reduce cerebral edema are administered to prevent the complication.