Abstract: PUB068
Dialysis Disequilibrium Syndrome After One Missed Dialysis Session in the Setting of Upper Gastrointestinal Bleeding
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Hashmi, Nooruddin, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
- Mira, Michael, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
- Khalil, Steve I., Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
Introduction
Dialysis disequilibrium syndrome (DDS) is seen at times in patients who have missed hemodialysis, usually after several missed sessions or in patients who are having their first session of hemodialysis. DDS is less common now due to the widespread use of decreased blood flow rates and dialysate flow rates in first start hemodialysis patients and similar preventative measures in patients who have missed several sessions of hemodialysis. The incidence of DDS is not well defined. Risk factors for DDS include first start hemodialysis patients, elevated BUN > 175 mg/dL, extremes of ages, prior neurological disease, concomitant cerebral edema from other causes, metabolic acidosis. In this case a patient missed one session of hemodialysis but due to an upper gastrointestinal bleed, his BUN was significantly elevated and led to him having DDS during dialysis.
Case Description
This is the case of a 58 year old male with past medical history of end stage renal disease on dialysis, prior gastrointestinal bleed who presented to the hospital with shortness of breath from symptomatic anemia secondary to upper gastrointestinal bleeding. The patient reported missing one session of hemodialysis due to his symptoms, which was later confirmed by his outpatient nephrologist. The patient had labs significant for potassium of 8.2 mmol/L, BUN 232mg/dL, Bicarbonate 15.7mmol/dL, Sodium 133mg/dL, creatinine of 10.4mg/dL. The patient was started on emergent hemodialysis for hyperkalemia. After two hours of hemodialysis (with a blood flow rate of 400 mL/min and dialysate flow rate of 700 mL/min, 1K bath) the patient began having atrial fibrillation with rapid ventricular response, altered mental status and concomitant shaking in his extremities. The patient was taken off dialysis and given benzodiazepines which resolved his symptoms. BUN after treatment was found to be 90 mg/dL.
Discussion
Often dialysis disequilibrium syndrome is associated with patients who are first started on hemodialysis or those with several missed dialysis sessions. There should be more discussion on the effect of upper GIB on BUN levels and the resulting dialysis disequilibrium syndrome that may occur.