Dialysis equilibrium syndrome is most common during the first few dialysis sessions. Typical presentation includes:

• A. Confusion, headache, and seizures
• B. Acute bone pain and confusion
• C. Weakness, tingling, and cardiac arrhythmias
• D. Hypotension, tachycardia, and tachypnea

Answer: (A)

Dialysis disequilibrium syndrome arises when solutes are cleared from the blood more rapidly than from the brain, creating an osmotic gradient that pulls water into brain cells and causes cerebral edema. This neurotoxic shift is most likely to cause symptoms early in treatment, before the brain has adapted to the rapid solute changes that occur during initial dialysis sessions. The hallmark presentation is neurologic: confusion, headache, and seizures, reflecting cerebral edema rather than primary electrolyte or hemodynamic issues. While other problems like bone pain, tingling with arrhythmias, or hypotension can occur with dialysis, they do not capture the classic neurologic triad of dialysis disequilibrium.