Unresponsive during or after dialyisis

[busyrninva]

So my mom is in the hospital with cardio renal syndrome and went into esrd. She started hemodialysis while in ccu and became rigid and non responsive. About 10 hours later she was able to answer yes/no but today she had another episode and is not talking at all. A ct was done to rule out a stroke and it was negative. It’s been about 15 hours and she is still non verbal and can’t follow commands. Her neck is hyper extended and no movements except to yawn She won’t even blink. I asked if she had a hypotension episode and they said no. She also has DIC and idiopathic thrombocytopenia with worsening liver function as well. Any ideas?

[SnipRN]

I am sorry to hear about your mother, I hope you've seen some improvement in the last couple days. My first thought was disequilibrium syndrome. It's pretty rare, but can happen during/after the first hemodialysis session. Basically, rapid removal of urea and ultrafiltration can create a greater concentration gradient in the brain/CSF than the rest of the body, leading to accumulation of fluid and increased intracranial pressure. If this were the case, however, I would think that the CT scan would have shown cerebral edema. Might also consider uremic encephalopathy.