{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:32:41Z","timestamp":1786984361984,"version":"build-2736575974"},"reference-count":7,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Rep Nephrol Dial"],"abstract":"<jats:p>Introduction: Dialysis disequilibrium syndrome is a serious complication occurring during hemodialysis initiation and after a break from hemodialysis, with a myriad of neurological symptoms. Case Presentation: We report a case of a 68-year-old woman with a history of hypertension, type 2 diabetes mellitus, and recently diagnosed end-stage kidney disease. She presented to the emergency room with disorientation and hypertensive urgency and had started hemodialysis 3 months prior but declined further treatment. Laboratory data revealed blood urea nitrogen of 151 mg\/dL, creatinine of 18 mg\/dL, bicarbonate level of 5 mEq\/L, and potassium of 6.6 mEq\/L. A temporary hemodialysis catheter was inserted, and dialysis was initiated with a blood flow rate of 300 mL\/min and a dialysate flow rate of 600 mL\/min, using an Optiflux 180NRe dialyzer (surface area 1.7 m2) for a duration of 3 h. The patient developed seizure activity after 2 h and 55 min, described as tonic-clonic seizure lasting 5 min. The urea reduction ratio was 57.6%, and the bicarbonate level increased from 5 to 16 mEq\/L. She remained in a stuporous state, with no response to stimuli. She was transferred to the intensive care unit and received 20% mannitol 0.5 g\/kg (40 g), followed by 3% hypertonic saline (30 mL bolus, then 50 mL\/h infusion), with the aim of maintaining a serum sodium concentration between 145 and 155 mEq\/L. Forty-eight hours later, she began to open her eyes to voice and consistently followed commands. Conclusion: Our patient\u2019s dialysis disequilibrium syndrome severity correlated with the urea reduction ratio and severe metabolic acidosis, highlighting the importance of achieving a low urea reduction ratio (&lt;40%) and a targeted rise in bicarbonate levels, both of which are risk factors for dialysis disequilibrium syndrome. In addition, the use of 3% saline and mannitol is an important preventive and rescue strategy.<\/jats:p>","DOI":"10.1159\/000553357","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T16:01:19Z","timestamp":1783094479000},"page":"113-118","source":"Crossref","is-referenced-by-count":0,"title":["Dialysis Disequilibrium Syndrome: A Severe Case with Neurologic Recovery \u2013 A Case Report"],"prefix":"10.1159","volume":"16","author":[{"given":"Ewalola Ayo","family":"Ijaduola","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Waheed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Bashir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1994.84"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1681\/asn.v661600"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-4758.2008.00270.x"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/s0272-6386(96)90124-9"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.89369"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/4964033"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2369-5-9"}],"container-title":["Case Reports in Nephrology and Dialysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000553357","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:00:43Z","timestamp":1786982443000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000553357"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000553357","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.32875892","asserted-by":"subject"}]},"ISSN":["2296-9705"],"issn-type":[{"value":"2296-9705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]}}}