Emergency Measures for Dialysis Patients Facing Acute Pulmonary Edema

Patient with kidney failure dies during emergency dialysis?

Hello Dr.
Huang: A friend of mine missed their scheduled dialysis on Monday due to work commitments.
After finishing work the next day, they felt unwell and went to the hospital for emergency dialysis.
Upon arrival, while waiting for the procedure, they experienced difficulty breathing and unfortunately passed away 40 minutes later before dialysis could be performed.
The cause of death was acute pulmonary edema.
I would like to ask, aside from waiting for dialysis, are there any other emergency measures that doctors can take for patients experiencing respiratory distress? Thank you!

A-Ming, 40~49 year old female. Ask Date: 2011/02/24

Dr. Huang Yaoxuan reply Internal Medicine

1.
For patients experiencing dyspnea (most dialysis patients typically present with acute pulmonary edema), if they are nearing respiratory failure, intubation may be considered, along with the use of a ventilator to assist with breathing (this is a theoretical scenario).
However, respiratory conditions can change rapidly, sometimes within minutes.
Additionally, the process of intubation (commonly referred to as endotracheal intubation) carries significant risks.
When the patient is conscious, sedatives and muscle relaxants are required to facilitate intubation, which can be quite painful.
Before intubation, "non-invasive positive pressure ventilation" (BiPAP) can be utilized.
Other options include diuretics (such as furosemide) and nitrites (such as nitroglycerin), but these medications can lower blood pressure.
During dialysis, dehydration can lead to a drop in blood pressure, so we generally avoid using antihypertensive medications prior to dialysis to ensure effective fluid removal.
2.
In my years of experience in the dialysis field, I frequently encounter situations similar to what you mentioned, where patients delay their dialysis treatments.
Some patients may feel asymptomatic and are reluctant to come for their scheduled sessions, and some even reduce their frequency of dialysis (from three times a week to two).
These behaviors are inappropriate and can lead to critical situations like the one you described (which can be life-threatening!).
Over time, this can result in inadequate clearance of uremic toxins, stemming from a lack of full awareness of their condition.
We can only do our best to counsel them.

Reply Date: 2011/02/24

More Info

Acute pulmonary edema in dialysis patients is a critical condition that requires immediate medical intervention. When a patient experiences acute pulmonary edema, especially in the context of renal failure, it can lead to severe respiratory distress and potentially fatal outcomes if not addressed promptly. In the scenario you described, where a patient was unable to undergo dialysis and subsequently developed respiratory distress, it highlights the urgency of managing such situations effectively.

Emergency Measures for Dialysis Patients Facing Acute Pulmonary Edema
1. Oxygen Therapy: The first step in managing acute pulmonary edema is to provide supplemental oxygen to the patient. This can help alleviate hypoxia and improve oxygenation, which is crucial for patients experiencing respiratory distress.

2. Diuretics: If the patient is conscious and able to take medications orally or intravenously, diuretics such as furosemide (Lasix) can be administered. Diuretics help to reduce fluid overload by promoting the excretion of excess fluid through urine, thereby alleviating pulmonary congestion.

3. Positioning: Positioning the patient in an upright or semi-upright position can facilitate easier breathing. This position helps reduce venous return to the heart and decreases the workload on the heart, which can be beneficial in cases of pulmonary edema.

4. Nitrates: In some cases, administering nitrates can help reduce preload and improve cardiac output. This can be particularly useful if the pulmonary edema is related to heart failure.

5. Mechanical Ventilation: If the patient’s respiratory distress is severe and they are unable to maintain adequate oxygenation, mechanical ventilation may be necessary. This can provide respiratory support until the underlying cause of the pulmonary edema is addressed.

6. Dialysis: Once the patient is stabilized, urgent dialysis should be initiated as soon as possible. Dialysis can effectively remove excess fluid and toxins from the body, which is critical in patients with renal failure.

7. Monitoring: Continuous monitoring of vital signs, oxygen saturation, and cardiac function is essential. This allows healthcare providers to assess the patient's response to treatment and make necessary adjustments.

8. Addressing Underlying Causes: It is also important to identify and treat any underlying causes of the acute pulmonary edema, such as heart failure, fluid overload, or other complications related to renal failure.

Conclusion
In summary, acute pulmonary edema in dialysis patients is a medical emergency that requires immediate intervention. While waiting for dialysis, healthcare providers can implement several emergency measures, including oxygen therapy, diuretics, and positioning, to stabilize the patient. The goal is to alleviate respiratory distress and prepare the patient for dialysis, which is crucial for managing fluid overload in renal failure.
In the case of your friend, it is unfortunate that the situation escalated so quickly. It underscores the importance of timely dialysis and the need for immediate medical attention when symptoms of pulmonary edema arise. Healthcare providers must be vigilant in monitoring patients with renal failure, especially those who miss scheduled dialysis sessions, as they are at a higher risk for complications such as acute pulmonary edema.

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