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Case Reports in Critical Care
Volume 2017 (2017), Article ID 5378928, 4 pages
https://doi.org/10.1155/2017/5378928
Case Report

Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury

1Department of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
2Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
3Department of Neurosurgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
4Department of Cardiothoracic Anaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

Correspondence should be addressed to Anton Lund; moc.liamg@2dnulnotna

Received 5 January 2017; Accepted 5 March 2017; Published 20 March 2017

Academic Editor: Kenneth S. Waxman

Copyright © 2017 Anton Lund et al. 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.

Abstract

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.