A patient with hyperkalemia and elevated urea levels underwent dialysis. Towards the end of the session, she became drowsy and had a sudden seizure episode. On examination, the patient was hypotensive. What is the treatment for this condition?

Options

1. Bumetanide
2. Ethacrynic acid
3. Nesiritide
4. IV Mannitol

Correct Answer

IV Mannitol

Explanation

This patient has Dialysis Disequilibrium Syndrome (DDS), which occurs due to: 1) Rapid removal of urea from blood during dialysis, 2) Urea clears slowly from brain → osmotic gradient, 3) Water moves into brain → cerebral edema, 4) Presents with: headache, nausea, confusion, seizures, altered consciousness, hypotension. Treatment: IV Mannitol (osmotic agent that reduces cerebral edema). Prevention: slower, shorter initial dialysis sessions, especially in patients with severe uremia or first dialysis. The syndrome is more common with rapid, aggressive dialysis in treatment-naive patients.

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