Managing Post-Dialysis Nausea and Dizziness: When to Seek Further Help

Frequent vomiting after dialysis?

My boyfriend has been on dialysis for over a year now.
Recently, he often feels dizzy after dialysis or the next day, and he frequently experiences vomiting.
Sometimes he vomits right after eating, and other times he rushes to the bathroom to vomit after feeling dizzy.
I asked the doctor at the dialysis clinic about this.
The first time, he mentioned that it might be due to excessive fluid removal (shouldn't the patient be informed if there are changes in the duration or volume of blood processed?).
The second time, he suggested that there might be an issue with the machine, and the last time he said that his creatinine (Cr) levels were too high.
I am unsure how to handle this situation now.
Should I take his recent dialysis reports to another major hospital for a second opinion?

Shen You Jia Shu, 30~39 year old female. Ask Date: 2013/11/13

Dr. Wu Jiyu reply Internal Medicine

Regarding dizziness and frequent vomiting after dialysis or the following day, we can discuss it in two parts: 1.
First, consider the quality of dialysis.
Is the dialysis adequate? Is there excessive weight gain between sessions? Is there poor blood pressure control? These factors may be related, so please discuss them with your nephrologist.
2.
Additionally, consider gastrointestinal function; for example, peptic ulcers or gastroesophageal reflux disease could also be potential causes.
It is recommended to arrange for an upper endoscopy for examination.
If any of these issues are present, there are medications available that can help.
Thank you for your inquiry; the Nephrology Department at Changhua Hospital cares about your well-being.

Reply Date: 2013/11/13

More Info

Managing post-dialysis nausea and dizziness can be quite challenging, especially when these symptoms persist or worsen over time. Your boyfriend's experience of feeling dizzy and nauseous after dialysis, along with vomiting, is concerning and warrants further investigation.
Firstly, it’s important to understand that dialysis is a critical treatment for patients with kidney failure, and it can have various side effects. Nausea and dizziness can occur for several reasons, including fluid imbalance, electrolyte disturbances, or complications related to the dialysis process itself. The fact that these symptoms have been persistent over the past month suggests that there may be an underlying issue that needs to be addressed.

1. Fluid Removal: One common cause of post-dialysis nausea and dizziness is the removal of too much fluid during the session. If the dialysis machine is set to remove more fluid than the patient can tolerate, it can lead to symptoms of hypotension (low blood pressure), which can cause dizziness and nausea. It is crucial for the dialysis team to monitor the patient’s weight and blood pressure closely to adjust the fluid removal accordingly. If your boyfriend has been experiencing these symptoms, it would be advisable to discuss with the dialysis staff about adjusting the ultrafiltration rate (the amount of fluid removed) during his sessions.

2. Electrolyte Imbalance: Another potential cause of these symptoms could be an imbalance in electrolytes, such as potassium, sodium, or calcium. High levels of creatinine (Cr) can indicate that the kidneys are not filtering waste effectively, which can lead to a buildup of toxins in the body. This can also contribute to nausea and dizziness. Regular blood tests are essential to monitor these levels, and if they are abnormal, adjustments in dialysis treatment or medications may be necessary.

3. Machine Issues: If the dialysis machine is malfunctioning, it could potentially lead to inadequate treatment, resulting in symptoms like nausea and dizziness. It is important for the dialysis center to ensure that all equipment is functioning correctly. If there are concerns about the machine, it may be worth discussing this with the staff to ensure that everything is operating as it should.

4. Seeking Further Help: If your boyfriend's symptoms continue despite adjustments made by the dialysis team, it may be prudent to seek a second opinion from a nephrologist at a larger hospital. Bringing in recent dialysis reports and lab results can provide valuable information for the new physician to assess the situation comprehensively. They may recommend additional tests or imaging studies to rule out other potential causes of his symptoms.

5. Monitoring Symptoms: Keep a detailed log of when the symptoms occur, their severity, and any associated factors (like food intake or changes in dialysis schedule). This information can be very helpful for healthcare providers in diagnosing the issue.

In conclusion, while nausea and dizziness post-dialysis can be common, persistent symptoms should not be ignored. It is essential to communicate openly with the dialysis team about these issues and advocate for your boyfriend's health. If necessary, seeking a second opinion can provide additional insights and help ensure that he receives the best possible care.

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