Dialysis Disequilibrium Syndrome in the Neurointensive Care Unit: A Case Study

Renal replacement therapy, especially hemodialysis, can exacerbate brain injury. The excessive ultrafiltration and rapid changes in blood pressure directly impact cerebral perfusion pressure. Substances that are typically added or removed during hemodialysis treatments alter serum osmolarity, shifting fluids into or out of the intracranial cavity. This results in changes in the intracranial pressure due to shrinking or swelling of the cerebral parenchyma, which if left untreated, can result in death. This article describes a case of dialysis disequilibrium syndrome and is an example of how astute nephrology nurses can directly impact the care of critically ill neurological patients.