Hemodialysis Dysequilibrium

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Classification according to ICD-10
E87.1 Hypoosmolality and hyponatremia
ICD-10 online (WHO version 2019)

The dialysis disequilibrium syndrome (also dialysis disequilibrium syndrome or Erstdialyse syndrome ) is a during a hemodialysis occurring complication . During hemodialysis, substances are quickly withdrawn from the blood (e.g. urea , NaCl) which, among other things, are osmotically effective.

The lowering of the concentration in the blood creates a concentration gradient with respect to the other body compartments , so that corresponding substances can pass into the blood via diffusion and are washed out. A specialty among the compartments is the central nervous system, which is surrounded by the blood-brain barrier and protected against the passage of toxic metabolites and other endogenous and exogenous neurotoxic substances. Diffusion at the blood-brain barrier is limited and delayed. If the concentration of osmotically active substances in the blood is lowered too quickly at extremely high concentrations, a concentration gradient occurs that cannot be compensated for in time by diffusion to the blood side at the blood-brain barrier. An osmotic gradient is built up, which leads to the concentration in the brain being reduced by "dilution", i.e. That is, water is stored and brain edema develops. The consequences are listed in more detail under symptoms . In severe cases, this can lead to coma or even death.

The same effect occurs with excessive alcohol consumption .

In practice, hemodialysis dysequilibrium has become rather rare (0.5% of dialysis patients). Modern dialysis machines ensure this through sensitive monitoring devices.

Symptoms

Individual evidence

  1. ↑ Alphabetical directory for the ICD-10-WHO Version 2019, Volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 204