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Patients undergoing hemodialysis are at risk for a neurological manifestation of fluid and electrolyte shifts called disequilibrium syndrome. This syndrome may be severe enough to produce altered consciousness, seizures, or coma, although typically it involves mild symptoms of malaise, nausea, and headaches. This syndrome is a diagnosis of exclusion, as many life‐threatening entities can cause similar symptoms. Thus, the renal patient with the new onset of these features requires prompt evaluation. Treatment is similar to that of cerebral edema with consideration of IV hypertonic therapy and termination of dialysis [4, 30].