Although typically seen in ESRD patients who are being initiated on hemodialysis, DDS can be seen in the critically ill
Critically ill patients at risk for DDS include recent CVA,head trauma,subdural hematoma,hyponatremia,, hypertensive emergency, and hepatic encephalopathy
Mild cases are characterized by restlessness, nausea, vomiting, headache, disorientation, and tremors
More severe symptoms include seizures and coma
The exact pathogenesis is debated but centers around acute cerebral edema
Treatment of DDS primarily centers around manipulation of hemodialysis
For the EP: patients with DDS presenting with seizures can be treated by rapidly increasing plasma osmolality with either hypertonic saline or mannitol (12.5 gms)
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