If you’re a nurse in an intensive care setting, then DDS is something that you need to take seriously. DDS is a potentially life-threatening complication of peritoneal and hemodialysis treatments, which can result in neurological deterioration if not treated quickly and effectively.
This blog post will discuss what causes DDS, the signs of onset nurses should look out for, and the best strategies to manage it with nursing interventions. So please keep reading to learn about this serious condition.
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What is DDS Meaning in Medical Terms?
The medical world is full of acronyms and abbreviations, which can confuse those unfamiliar with their meanings. One such abbreviation is DDS, which stands for dialysis disequilibrium syndrome.
This condition can cause neurological symptoms and is primarily seen in patients new to dialysis or who have missed regular treatments. Experts believe that DDS may develop due to fluid shifts during hemodialysis, which can cause cerebral edema and neurological dysfunction. Fortunately, continuous renal replacement therapies (CRRT) have been shown to limit fluid changes and minimize the risk of DDS.
Symptoms of DDS include headaches, nausea, vomiting, confusion, and even seizures. While rare, medical professionals must be aware of DDS and its potential risks to provide their patients with the highest level of care.
First Case History In (DDS) Meaning Medical World:
Dialysis disequilibrium syndrome is a rare condition first reported in medical literature in 1962. Despite the time that has passed, the incidence of this syndrome is not yet accurately defined due to its non-specific symptoms and difficulty in confirming the diagnosis. With this in mind, DDS is likely underreported, particularly in high-risk groups and cases where rapid hemodialysis is used.
Despite this, the overall incidence has decreased over time due to increased awareness about this condition and preventive measures being put in place. This highlights the importance of continued education and research to fully understand dialysis disequilibrium syndrome and improve patient outcomes in the long run.
Etiology (Common Risk factors For Patients)
The common risk factors that predispose a patient to dialysis disequilibrium syndrome are listed as follows:
- Impaired autoregulation of cerebral blood flow due to a low glomerular filtration rate
- Fluid shifts during dialysis treatments
- Changes in electrolytes concentrations
- Acid-base imbalances
- High BUN (above 175 mg/dL or 60 mmol/L) before dialysis initiation, extremes of age
- Sudden changes to the dialysis regimen
- Pre-existing neurological diseases such as stroke, malignant hypertension, head trauma or seizure disorder,
- Anything causing cerebral edema (hyponatremia, hepatic encephalopathy),
- Conditions resulting in increased blood-brain barrier permeability (sepsis, meningitis, encephalitis, hemolytic uremic syndrome, vasculitis) must all be considered before beginning hemodialysis treatment.
Pathophysiology Of DDS
Sudden electrolyte concentrations and fluid balance alterations during dialysis treatments cause DDS. This imbalance of fluids can lead to increased intracranial pressure due to cerebral edema, which can impair the brain’s functioning.
It is theorized that the onset of dialysis disequilibrium syndrome (DDS) could be attributed to osmotic shifts resulting from urea and changes in pH within brain cells caused by carbon dioxide retention.
The reverse osmotic shift theory suggests that a rapid drop of blood urea levels during hemodialysis, especially in patients with elevated pre-session levels, decreases plasma osmolality and creates a gradient between these cells and those of the brain.
Subsequently, water follows this gradient into the brain cells leading to cerebral edema. Another theory is that dialysis induces a CO2 gradient between plasma and cerebrospinal fluid (CSF), which lowers the pH of brain tissue.
This increases osmolality due to a higher concentration of hydrogen ions and acid radicals, pulling water into the cells and leading to cerebral edema. If not dealt with in time, DDS can cause severe increases in intracranial pressure that may lead to herniation of the brain and death.
The exact mechanism by which this occurs has yet to be well understood, but it is believed that it is due to the shifts of fluid, electrolytes, and metabolites across the blood-brain barrier. This can cause an influx of sodium into the brain, leading to increased intracranial pressure and cerebral edema.
Additionally, these changes can disrupt normal neurological functioning and may result in severe neurological symptoms such as seizures or coma.
Disequilibrium Syndrome Nursing Interventions and Actions
Therapeutic interventions and nursing actions for patients on peritoneal dialysis may include:
Promoting Fluid Balance
Monitor and document all intake and output, including body fluids such as wound drainage, nasogastric fluid, and diarrhea. Keeping track of inflow and outflow volumes and cumulative fluid balance can help assess whether the sufficient or deficient volume is being removed during dialysis.
Additionally, measuring hemoglobin (Hgb) and hematocrit (Hct) levels and replacing blood components, when necessary, may help reduce any associated risks. This information can indicate the patient’s fluid loss or gain at the end of each exchange.
This is important given under-dialysis in average or near regular hematocrit patients and suggests the need to modify dialysis prescriptions in such situations.
Strictly adhere to the schedule for draining dialysate from the abdomen. Longer dwell times, especially when a 4.5% glucose solution is employed, can lead to excessive dehydration. Measure body weight at the start of treatment and after 6–10 runs, then as per indication.
This helps detect the rate of fluid removal by comparing it with baseline body weight. Furthermore, monitor vital signs consistently and report any indications of pericarditis (e.g., pleuritic chest pain, elevated heart rate, pericardial friction rub), inadequate renal perfusion (low blood pressure), or acidosis. Those with end-stage renal disease (ESRD) may be prone to developing Pericard disease.
To promote fluid balance, you can take the following steps:
- Monitor BP (lying and sitting) and pulse. Note the level of jugular pulsation.
- Note reports of dizziness, nausea, and increased thirst.
- Inspect mucous membranes, and evaluate skin turgor, peripheral pulses, and capillary refill.
- Monitor laboratory studies as indicated: Serum sodium and glucose levels.
- Managing Effective Breathing Patterns
- Monitor lung sounds and oxygen saturation.
- To evaluate the effectiveness of breathing patterns.
- Administer oxygen if indicated.
- To ensure adequate oxygenation of tissues.
- Encourage deep breathing exercises, coughing, postural drainage, and chest percussion (if ordered).
- Promote expectoration of pulmonary secretions with an incentive spirometer or other breathing device.
- Ensure adequate ventilation and prevent infection.
- Assist the patient with assisted devices (e.g., nasal cannula, ventilator).
- To provide appropriate respiratory support.
- Monitor electrolyte levels accurately and adjust the dialysate solutions prescribed.
- To prevent, detect, and treat electrolyte imbalances.
- Monitor level of consciousness, vital signs, and patient complaints of headache or nausea.
- To identify changes in neurologic status that may indicate the onset of cerebral edema.
- Alert the physician to signs/symptoms of dialysis disequilibrium syndrome, such as confusion, nausea, vomiting, muscle twitching/cramping, or seizures.
- To provide early treatment for this condition.
Monitoring Neurological Status
- Assess motor and sensory function regularly (e.g., level of consciousness, reflexes)
- To detect changes in neurologic status that may indicate the onset of cerebral edema.
- Monitor mental status, including orientation, memory, and judgment.
- To assess the patient’s ability to understand and comply with the treatment regimen.
Providing Emotional Support
Encourage verbalization of concerns/fears regarding diagnosis, treatments, prognosis, and lifestyle changes.
- To allow expression of emotions and provide emotional support.
- Provide accurate information about the disease process, dialysis treatments, and lifestyle changes.
- To promote understanding of the treatment plan.
- Assist patient/family in exploring resources for financial assistance to cover medical expenses not covered by insurance or third-party payers.
- To ensure the availability of necessary care and services.
- Administer medications as ordered, monitoring for adverse reactions.
- To ensure correct administration of medications and prevention of unnecessary side effects.
Monitoring Fluid Balance
Monitor inflow and outflow volumes of fluids, individual and cumulative fluid balance, Hgb/Hct levels, and body weight.
- To determine loss or gain at the end of each exchange.
- Discuss any changes in fluid balance with the physician and initiate corrective measures as indicated.
- Ensure the proper fluid balance is maintained.
Preparing for Discharge
Provide patient and family with information about dialysis access care, diet, medications, fluid restrictions, signs/symptoms of complications, and follow-up appointments.
- Ensure the patient has all the necessary knowledge to continue treatment after discharge.
- Reinforce teaching regarding self-care and management of access sites.
- To prevent infection and promote healing.
- Discuss the need for home care or an outpatient dialysis center with the patient/family.
- To provide necessary resources for continuing care.
Require Treatments for DDS
Treatments for dialysis disequilibrium syndrome (DDS) include:
- Gradually decreasing the amount of dialysate used
- Modifying the rate of blood flow
- Increasing the number of dialysis treatments per week
- Reducing sodium intake, and
- Monitoring electrolyte levels
In addition to these interventions, medications such as diuretics may be prescribed to reduce fluid buildup in the body, and calcium gluconate or bicarbonate may be given as part of treatment for cerebral edema.
In severe cases, ultrafiltration may quickly remove excess fluid from the body. It is important to note that treatments are individualized for each patient and based on their needs.
Dialysis Disequilibrium Syndrome Prevention
Preventing DDS involves careful monitoring of fluids and electrolytes during dialysis treatments. Proper scheduling of dialysis sessions, adequate fluid intake between sessions, and strict adherence to prescribed dietary plans can help reduce the risk of developing DDS.
In addition, patients should be monitored for signs and symptoms of dehydration or fluid overload, as these can contribute to developing DDS. Finally, patients need to report any signs or symptoms of DDS to their healthcare provider as soon as possible so that appropriate actions can be taken.
These measures can help prevent DDS and ensure dialysis treatments successfully manage kidney failure.
Additional measures that may be utilized for DDS:
- Administer hypertonic saline or mannitol (an osmotic diuretic) to help reduce cerebral edema by decreasing the amount of fluid inside brain cells.
- Transition patients to a slow, steady type of renal replacement therapy.
- In mechanically ventilated patients, hyperventilate them to remove excess carbon dioxide and decrease intracranial pressure.
- Control restlessness and nausea with appropriate medications such as ondansetron or benzodiazepines.
Mrs. Marie Brown has been a registered nurse for over 25 years. She began her nursing career at a Level I Trauma Center in downtown Chicago, Illinois. There she worked in the Emergency Department and on the Surgical Intensive Care Unit. After several years, she moved to the Midwest and continued her nursing career in a critical care setting. For the last 10 years of her nursing career, Mrs. Brown worked as a flight nurse with an air ambulance service. During this time, she cared for patients throughout the United States.