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Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury
Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy....
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376919/ https://www.ncbi.nlm.nih.gov/pubmed/28409034 http://dx.doi.org/10.1155/2017/5378928 |
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author | Lund, Anton Damholt, Mette B. Strange, Ditte G. Kelsen, Jesper Møller-Sørensen, Hasse Møller, Kirsten |
author_facet | Lund, Anton Damholt, Mette B. Strange, Ditte G. Kelsen, Jesper Møller-Sørensen, Hasse Møller, Kirsten |
author_sort | Lund, Anton |
collection | PubMed |
description | Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT) revealed an inferior vena cava aneurysm and multiple pulmonary emboli as the likely cause. An intracranial pressure (ICP) monitor was inserted, and, on day 3, continuous renal replacement therapy (CRRT) was initiated due to acute kidney injury, during which the patient developed severe intracranial hypertension. CT of the brain showed diffuse cerebral edema. CRRT was discontinued, sedation was increased, and hypertonic saline was administered, upon which ICP normalized. Due to persistent hyperkalemia and overhydration, ultrafiltration and intermittent hemodialysis were performed separately on day 4 with a small dialyzer, low blood and dialysate flow, and high dialysate sodium content. During subsequent treatments, isolated ultrafiltration was well tolerated, whereas hemodialysis was associated with increased ICP necessitating frequent pauses or early cessation of dialysis. In patients at risk of DDS, hemodialysis should be performed with utmost care and continuous monitoring of ICP should be considered. |
format | Online Article Text |
id | pubmed-5376919 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-53769192017-04-13 Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury Lund, Anton Damholt, Mette B. Strange, Ditte G. Kelsen, Jesper Møller-Sørensen, Hasse Møller, Kirsten Case Rep Crit Care Case Report Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT) revealed an inferior vena cava aneurysm and multiple pulmonary emboli as the likely cause. An intracranial pressure (ICP) monitor was inserted, and, on day 3, continuous renal replacement therapy (CRRT) was initiated due to acute kidney injury, during which the patient developed severe intracranial hypertension. CT of the brain showed diffuse cerebral edema. CRRT was discontinued, sedation was increased, and hypertonic saline was administered, upon which ICP normalized. Due to persistent hyperkalemia and overhydration, ultrafiltration and intermittent hemodialysis were performed separately on day 4 with a small dialyzer, low blood and dialysate flow, and high dialysate sodium content. During subsequent treatments, isolated ultrafiltration was well tolerated, whereas hemodialysis was associated with increased ICP necessitating frequent pauses or early cessation of dialysis. In patients at risk of DDS, hemodialysis should be performed with utmost care and continuous monitoring of ICP should be considered. Hindawi 2017 2017-03-20 /pmc/articles/PMC5376919/ /pubmed/28409034 http://dx.doi.org/10.1155/2017/5378928 Text en Copyright © 2017 Anton Lund et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Lund, Anton Damholt, Mette B. Strange, Ditte G. Kelsen, Jesper Møller-Sørensen, Hasse Møller, Kirsten Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury |
title | Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury |
title_full | Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury |
title_fullStr | Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury |
title_full_unstemmed | Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury |
title_short | Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury |
title_sort | increased intracranial pressure during hemodialysis in a patient with anoxic brain injury |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376919/ https://www.ncbi.nlm.nih.gov/pubmed/28409034 http://dx.doi.org/10.1155/2017/5378928 |
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