Blood Pressure Drops and Nausea During Dialysis

Q: Blood Pressure Drops and Nausea During Dialysis

Hello： There are many causes of intradialytic hypotension (IDH) during dialysis： excessive weight gain between dialysis sessions (> 5%), heart failure, malnutrition, female gender, autonomic nervous system dysfunction, etc., are common causes. <br><br>1. <br>If there is excessive

Dialysis issues

The links provided lead to recent blood test reports.
I would like to ask the doctor why my grandmother often experiences a drop in blood pressure, confusion, and nausea during the dialysis process.
When we asked her attending physician, the doctor only advised us to control her fluid intake, but my grandmother already drinks very little fluid.
Could you please explain what other reasons might cause these symptoms? My grandmother is feeling so unwell that she no longer has the desire to continue dialysis.

Miss Huang, 30~39 year old female. Ask Date: 2022/06/02

Dr. Wu Hongjie reply Internal Medicine

Hello: There are many causes of intradialytic hypotension (IDH) during dialysis: excessive weight gain between dialysis sessions (> 5%), heart failure, malnutrition, female gender, autonomic nervous system dysfunction, etc., are common causes.

1.
If there is excessive weight gain between dialysis sessions, it is recommended to perform dialysis more frequently and for longer durations in smaller amounts to alleviate the issue.

2.
In cases of heart failure, an echocardiogram should be performed, and a consultation with a cardiologist is advised to rule out any problems.

3.
For those with autonomic nervous system dysfunction, it is suggested that the amount of fluid removed should not be excessive, and control of fluid and salt intake is important.
If necessary, antihypertensive medications (such as MIDODRINE) may be used half an hour before dialysis or during the dialysis session.
It is advisable to avoid antihypertensive medications on the day of dialysis and to maintain blood pressure at a slightly higher level.

Wishing you health and safety.

Reply Date: 2022/06/02

More Info

Understanding the challenges faced during dialysis, particularly concerning blood pressure drops and nausea, is crucial for ensuring the well-being of patients undergoing this life-sustaining treatment. Your grandmother's experience of experiencing low blood pressure, confusion, and nausea during dialysis is not uncommon, and several factors could contribute to these symptoms.

Firstly, dialysis itself can lead to fluctuations in blood pressure. During the procedure, excess fluid is removed from the body, which can cause a rapid decrease in blood volume. This reduction can lead to hypotension (low blood pressure), resulting in symptoms such as dizziness, confusion, and nausea. The body may struggle to adapt to these changes, especially in patients who are already vulnerable due to age or other health conditions.

In addition to fluid removal, other factors can exacerbate blood pressure drops during dialysis. For instance, the composition of the dialysis solution, the rate of fluid removal, and the patient's overall cardiovascular health can all play significant roles. If the dialysis is too aggressive, it can lead to rapid shifts in fluid balance, causing the blood pressure to drop sharply. This is particularly concerning for elderly patients or those with pre-existing heart conditions, as their bodies may not tolerate these changes well.

Moreover, the patient's nutritional status and electrolyte levels can also impact their response to dialysis. For example, imbalances in electrolytes such as sodium and potassium can lead to cardiovascular instability. If your grandmother's blood tests indicate any abnormalities in these levels, it may be necessary to adjust her dialysis regimen or dietary intake accordingly.

It's also important to consider the role of medications. Some patients on dialysis may be taking antihypertensive medications that can further lower blood pressure during treatment. If your grandmother is on such medications, her healthcare provider may need to reassess her medication regimen to prevent excessive drops in blood pressure during dialysis sessions.

In terms of managing her symptoms, it is essential to communicate openly with her healthcare team. If your grandmother is experiencing significant discomfort or a lack of willingness to continue dialysis, it may be time to explore alternative options or adjustments to her treatment plan. This could include modifying the dialysis schedule, adjusting the fluid removal rate, or even considering palliative care options if her quality of life is severely impacted.

Additionally, ensuring that your grandmother is adequately hydrated before dialysis (within the limits set by her healthcare provider) can help mitigate some of the blood pressure drops. However, this must be balanced with her overall fluid management plan, as fluid overload can also lead to complications.

In conclusion, the symptoms your grandmother is experiencing during dialysis are multifactorial and require a comprehensive approach to management. It is crucial to work closely with her healthcare team to identify the underlying causes and make necessary adjustments to her treatment plan. Open communication about her symptoms and concerns will help ensure that she receives the best possible care and support during this challenging time.

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