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....
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Critical Care |
| Online Access: | http://dx.doi.org/10.1155/2017/5378928 |
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| author | Anton Lund Mette B. Damholt Ditte G. Strange Jesper Kelsen Hasse Møller-Sørensen Kirsten Møller |
| author_facet | Anton Lund Mette B. Damholt Ditte G. Strange Jesper Kelsen Hasse Møller-Sørensen Kirsten Møller |
| author_sort | Anton Lund |
| collection | DOAJ |
| 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 | Article |
| id | doaj-art-2cd064f45570487a9c26d4feca563c91 |
| institution | Kabale University |
| issn | 2090-6420 2090-6439 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Critical Care |
| spelling | doaj-art-2cd064f45570487a9c26d4feca563c912025-08-20T03:55:02ZengWileyCase Reports in Critical Care2090-64202090-64392017-01-01201710.1155/2017/53789285378928Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain InjuryAnton Lund0Mette B. Damholt1Ditte G. Strange2Jesper Kelsen3Hasse Møller-Sørensen4Kirsten Møller5Department of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of Neurosurgery, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of Cardiothoracic Anaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkDialysis 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.http://dx.doi.org/10.1155/2017/5378928 |
| spellingShingle | Anton Lund Mette B. Damholt Ditte G. Strange Jesper Kelsen Hasse Møller-Sørensen Kirsten Møller Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury Case Reports in Critical Care |
| 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 |
| url | http://dx.doi.org/10.1155/2017/5378928 |
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