Dialysis Disequilibrium Syndrome as a Cause of Unexplained Pain in a Young Female: A Case Report

Unexplained pain can be challenging to diagnose, especially when the workup is unremarkable. For this young woman, her symptoms appeared consistent with dialysis disequilibrium syndrome (DDS), a neurological sequela that occurs in the first few months after beginning dialysis. Due to the nonspecific presentation and difficulty in confirming this syndrome, physicians should be aware of this as a potential cause of pain in dialysis patients. This case involves a 27-year-old woman with a past medical history of type 1 diabetes mellitus (T1DM), gastroparesis, hypertension, recurrent pyelonephritis, hyperlipidemia, depression, and end-stage renal disease secondary to poorly controlled T1DM (on dialysis), who presented with a three-day history of severe left flank and right upper quadrant pain, abdominal distension, nausea, vomiting, bilateral leg swelling, and headache. She stated she had been getting similar pain since she began receiving dialysis four months prior to her presentation. After emergent hemodialysis in the hospital, she developed worsening 10/10 generalized abdominal pain with severe tenderness, headache, nausea, chest pain, and palpitations. All workups came back negative. Given these findings, symptoms appeared consistent with DDS. This patient struggled with a nonspecific array of symptoms that originally did not point toward any one diagnosis. Her symptoms would become even more severe when she missed dialysis sessions and subsequently completed her sessions a few days late, fitting the clinical picture of DDS. Once DDS is suspected, several measures can be taken to prevent symptoms, including administering hypertonic saline, utilizing hemofiltration in place of hemodialysis, and prolonging dialysis sessions.