Nausea and Dizziness in Dialysis Patients: Causes and Solutions

Q: Nausea and Dizziness in Dialysis Patients: Causes and Solutions

Hello： In response to your question, based on your description, your father appears to have developed uremia due to diabetes mellitus complicated by hypertension, necessitating hemodialysis treatment. <br>After dialysis, symptoms such as dizziness, vomiting, and cold sweats may o

Dialysis patients often experience vomiting and dizziness?

Hello Doctor, my father started dialysis at the end of January this year, just before the Lunar New Year.
He did not feel particularly unwell initially, but in the past month, after undergoing dialysis at the hospital, he has experienced persistent vomiting, dizziness, and cold sweats.
Often, he goes to the emergency room in the afternoon after his morning dialysis session.
My father weighs about 74 kg and his weight drops to around 70 kg after dialysis.
His blood pressure frequently reaches as high as 200.
He has diabetes and a smoking habit, which have remained unchanged.
The only difference is that my father underwent surgery to remove a blood clot from his eye on April 24.
However, the symptoms mentioned above began to appear about three weeks prior to the surgery.
I would like to ask the doctor why this is happening.
Our family is very worried, and we hope the doctor can clarify our concerns.
Thank you!

A-Jia, 20~29 year old female. Ask Date: 2006/05/01

Dr. Yang Jun reply Internal Medicine

Hello: In response to your question, based on your description, your father appears to have developed uremia due to diabetes mellitus complicated by hypertension, necessitating hemodialysis treatment.
After dialysis, symptoms such as dizziness, vomiting, and cold sweats may occur, which could be indicative of hypoglycemia due to a drop in blood sugar during the procedure; or it could be related to excessive food intake between dialysis sessions; or significant weight gain leading to increased dehydration during dialysis, which can cause a drop in blood pressure.
It is essential to consult with the nephrologist and nurses in the dialysis unit regarding these issues.
Additionally, it is important to monitor dietary intake, avoiding excessive sweets and salt, and to reduce fluid intake to manage weight and blood sugar levels.
The aforementioned symptoms are not related to eye surgery.

Reply Date: 2006/05/01

More Info

Nausea and dizziness in dialysis patients can be concerning symptoms, especially when they lead to frequent emergency visits. Understanding the potential causes and solutions is crucial for managing these symptoms effectively.

Causes of Nausea and Dizziness in Dialysis Patients
1. Fluid and Electrolyte Imbalance: Dialysis patients often experience fluctuations in fluid and electrolyte levels due to the removal of excess fluids and waste products. This can lead to dehydration or overhydration, both of which can cause nausea and dizziness. For instance, if your father is experiencing rapid weight loss during dialysis, it may indicate that too much fluid is being removed too quickly.

2. Blood Pressure Changes: Dialysis can cause significant changes in blood pressure. Hypotension (low blood pressure) is a common complication during or after dialysis, which can lead to dizziness and nausea. Conversely, if your father's blood pressure is frequently high (as noted at 200 mmHg), this could also contribute to these symptoms, particularly if he is experiencing hypertensive crises.

3. Dialysis Disequilibrium Syndrome: This condition can occur when there is a rapid change in the body's fluid and electrolyte balance during dialysis. Symptoms can include headache, nausea, vomiting, and confusion. It is more common in patients who are new to dialysis or have significant residual kidney function.

4. Medication Side Effects: If your father is taking medications for diabetes or hypertension, these could contribute to nausea and dizziness. Some medications can cause gastrointestinal upset or affect blood pressure regulation.

5. Underlying Health Conditions: Your father's history of diabetes and smoking can complicate his overall health status. Diabetes can lead to autonomic neuropathy, which may affect blood pressure regulation and contribute to dizziness.

6. Post-Surgical Effects: The recent eye surgery could also play a role in his symptoms, especially if he was under anesthesia or if there were any complications that could affect his overall health.

Solutions and Recommendations
1. Monitor Fluid Intake: It's essential to manage fluid intake carefully. Your father's dialysis team should provide guidelines on how much fluid he can safely consume between sessions. Keeping a daily log of fluid intake and weight can help monitor changes.

2. Adjust Dialysis Settings: If nausea and dizziness persist, it may be necessary to adjust the dialysis settings. This could include changing the rate of fluid removal or the duration of dialysis sessions. Discussing these symptoms with the nephrologist can lead to tailored adjustments.

3. Blood Pressure Management: Regular monitoring of blood pressure before, during, and after dialysis is crucial. If his blood pressure is consistently high, medications may need to be adjusted. Conversely, if he experiences low blood pressure, the dialysis team may need to take measures to prevent hypotension during treatment.

4. Medication Review: A comprehensive review of all medications is essential to identify any potential side effects contributing to nausea and dizziness. The healthcare provider may consider alternative medications or dosages.

5. Dietary Considerations: A dietitian specializing in renal nutrition can provide guidance on dietary choices that can help manage blood pressure and overall health. This includes monitoring sodium intake and ensuring adequate caloric and nutrient intake.

6. Emergency Plan: Given the severity of his symptoms, it’s important to have a clear plan for when to seek emergency care. If he experiences severe dizziness, persistent vomiting, or any other alarming symptoms, he should seek immediate medical attention.

Conclusion
The symptoms your father is experiencing are not uncommon in dialysis patients, but they warrant careful evaluation and management. Collaborating closely with his healthcare team, including nephrologists, dietitians, and possibly cardiologists, will be key in addressing these issues effectively. Regular follow-ups and open communication about his symptoms will help alleviate anxiety and improve his quality of life.

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