CONSULT ROUNDS

Here is a case of BUN of 260 and creatinine of 14 on presentation and K of 7.5.
Dialysis disequilibrium syndrome (DDS) was the main focus of discussion.


FOCUS: TREATMENT AND PREVENTION OF THE SYNDROME ( WANT TO PREVENT THE FALL IN THE PLASMA OSMOLALITY TO PREVENT THE SHIFTING OF WATER IN THE BRAIN CELLS)
1. The initial dialyses should be gentle, but repeated frequently. 
2. Two hours of hemodialysis with BFR of 150-250ml/min 
3. Use small surface dialyzer
4. Prophylactic benzodiazepines
5. Prophylactic phenytoin 
6. Administration of mannitol IV every hour of dialysis 
7. High Na bath
8. Severe DDS with seizures can be reversed more rapidly by raising the plasma osmolality with either 5 mL of 23 percent saline or 12.5 g of hypertonic mannitol.