Edema cerebral agudo por síndrome de desequilibrio dialítico: reporte de caso
Reporte de caso
DOI:
https://doi.org/10.69825/cienec.v8i35.392Abstract
Introducción: El síndrome de desequilibrio en diálisis es un trastorno neurológico agudo que puede aparecer durante o después de la hemodiálisis y asociarse con edema cerebral. Presentación del caso: Mujer de 49 años con enfermedad renal crónica en hemodiálisis trisemanal, hipertensión arterial, diabetes mellitus tipo 2, retinopatía con discapacidad visual y hematoma subdural laminar derecho traumático. Recibía sesiones incompletas por hipotensión recurrente y disfunción del acceso vascular. Luego de colocar un catéter temporal yugular derecho, se realizó hemodiálisis durante cuatro horas con ultrafiltración de 2 500 mL. Durante el procedimiento presentó deterioro del estado de conciencia, inicialmente con Glasgow 13/15, y fue trasladada al hospital. Al ingreso presentó Glasgow 7/15. Antes de la diálisis tenía urea 417 mg/dL, creatinina 13 mg/dL, potasio 8,4 mEq/L, sodio 132 mEq/L, hemoglobina 6,2 g/dL y hematocrito 18%. Después de la diálisis, la urea fue 207 mg/dL, la creatinina 7,2 mg/dL y el potasio 5,0 mEq/L. La tomografía cerebral mostró edema cerebral y hematoma subdural hemisférico derecho crónico. Se diagnosticó síndrome de desequilibrio en diálisis. La paciente requirió ventilación mecánica invasiva, cuidados intensivos, solución hipertónica y sesiones posteriores de diálisis con flujos y ultrafiltraciones menores. Evolucionó favorablemente y fue dada de alta. Conclusión: El síndrome de desequilibrio en diálisis debe considerarse ante deterioro neurológico agudo relacionado temporalmente con la hemodiálisis, especialmente en presencia de hiperazoemia marcada y sesiones dialíticas previas incompletas.
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