Cramping

[kidneysblowingchunks]

I am only in my second week of Dialysis. The first few sessions went well. Friday, I had a different tech who decided 3 kg was to be removed. Nothing was reviewed that I know of. During the treatment I started cramping.
The cramps got so bad that I stood up in about 1.5 seconds. The staff was worried that I would pull my cath lines out. I held onto them for safety.They added Saline.

The cramps continued when I woke up in the middle of the night at home.
My room mate asked what was wrong with me. I told her that During the dialysis process, excess fluids are removed. Someone set the machine to "Beef Jerky". and then described what happened.

I plan to talk to the charge nurse. What do I ask? What do I need to know?

Any help would be appreciated.




 Mind you, my dry weight has not been determined. I also still have good urine output.

[Pam]

At my center the techs do not set how much fluid to remove. The RN sets that when we weigh in. She always tells me how much they are going to remove, and I have choice to accept or challenge it.

Pam

[Wallyz]

You need to figure out what your dry weight is.  I would start aiming for a kg above where this tech wanted it.

[qwerty]

Until your EDW is established I wouldnt allow them to take any more than 2kg to start and then challenge by 0.5 each time. If your cramping they are taking way too much off.  If EDW hasnt been established then 3kg to start is too much. Also many times I see the opinion that if you are on dialysis then you need to have fluid removed which may be very far from the truth when you have a client that urinates just as good as before renal failure set in. Sometimes it's only the "cleaning" needing done and not fluid removal. In this case I would set the UF at minimum and supplement normal saline to send someone out at what they came in at if not fluid gain. Also getting techs to understand sometimes you may have gained real weight can be difficult. This is where it's best for care givers to listen to the client!! Know your body and what is right for you. Speak up and let them know you are still in control of your care. You shouldnt be leaving dialysis feeling like crap or cramping at home. It a real misconception with dialysis workers that fluid "has" to be removed on some clients.

[RichardMEL]

lol @ beef jerky.. that's pretty funny.

Cramping though is not.

You're still new and I'm surprised they just pulled a figure out of the air. If they pulled 2kg one time, pulling 3 the next would not be right because there's no baseline. Certainly what you need to do at this point is try and remember how much they'd taken off when you cramped. Let's say it was 1.5kg. Take that off the weight you went in at and set say that weight plus 200ml or so as your own personal dry weight. Then next time you go in and compare your "wet weight" (ie: what you weigh when you go in) take away your "personal dry weight" from that and if they want to take off MORE than that amoiunt (accounting for washback of course)... say NO! If they question it you explain you cramped after X was taken off last time and you want to work to establish your dry weight, not take off too much fluid. If they push back then I'd say to them "OK, how do you suggest we determine an appropriate dry weight without taking too much off and me cramping again?" if they keep pushing ask to talk to a supervisor/manager or something. Ask for a BVM/BCM/crit line(whatever they want to call it) to measure how well you are refilling. That will give a good indication of where you are at fluid wise. I think as long as you are reasonable and explain where you got your "personal dry weight" from they should work with you to try and get fluid off without you cramping.

good luck!

[Maker]

I am interested to read some of these comments about dry weight because this has been an issue for me.  I will start my 4th week of dialysis tomorrow.  When I began I had some extra fluid on me, but now I don't and I still urinate.

 I kept coming in 1/2 or 1 KG lighter than I was when I left and my Neph adjusted my dry weight down a couple times, but now he refuses to adjust it again.  It seems like what he says goes, no matter what.  If I come in 1 KG below my dry weight, the nurses won't let me leave until they give me enough fluid to get me up to my dry weight, and they make me go weigh before they take down the machine.  I protest to them that I feel great (My BP stays steady, it never drops!)  and I don't feel like I need any fluid but they say Dr. wants me at this weight 

We aren't supposed to eat or drink anything at my facility but I have resorted to sneaking in bottles of water and coffee to drink during dialysis so they won't pump me full of fluids 

What's up with this? Shouldn't they be listening to me?  I really don't understand this dry weight thing at all, so its very possible that I am way off base    Thanks guys for the info 

[MissyKew]

You all just confused the heck out of me and I have been on hemo since end of July.  We don't seem to get much choice in the decision on how much fluid is taken off.  I have had too much fluid taken off and gone home and had cramps for the rest of the day.  Not a lot of fun.

[RichardMEL]

Gee Lori, that seems quite odd to me. Clearly you're not cramping or showing any signs that the fluid loss is a problem for you, which suggests you may still be carrying a little bit (ie: a bit wet - not behind the ears though!) and that you could do with some more off. The neph's concern may be that you're losing body weight rather than fluid weight, but just adding saline to you won't do anything about that anyway. It seems a bit odd to treat you that way.

If it was me I'd ask the neph why he has set this particular weight and won't change it. If you're outputting a fair bit and coming in UNDER your dry weight that suggests to me (yeah, I'm an expert.. NOT!) that you're shedding fluid which is a GOOD thing - at the very least it seems your body is putting out the extra they give you, so I would have thought setting your dry weight at that kilo under or whatever you come in at would be fine - at the very least if you're tolerating it don't give any extra !!

The neph should have a reasonable reason for his decision. Dry Weights are a bit of a guestimate, but in my experience they er on the side of taking weight off until you find a level where you see something like BP falling or so on that indicates you're drying out.

Again if it were me and I didn't think the neph's reasons were reasonable I would request a BVM/BCM/crit line to get an idea of how my fluids were really doing rather than just a guestimate.

And finally YES I agree they should listen to you - you're the patient!!!

I've found if you talk to the medical stuff with some understanding of the issues and your own body they will treat you with more respect and work WITH you not against you. I think the general consensus out there is that most patients are clueless, and further don't care about the details of their treatment(I see lots of patients that don't care and don't want to know about the settings on their machine, what it means, why, or even what their own lab values are and why it's important - they just let the medical staff worry about it. For me I *do* care because nobody is going to care about my body and what is going on as me!!! I'm not willing to just lie back and let others-who are human and can make mistakes or misjudge things - decide what is going to happen to me!).

Good luck!!!!

[Maker]

Thanks so much Richard, that's exactly what I thought!!  If my BP isn't dropping and I'm not cramping than obviously I have extra fluid.  I don't know what BVM/BCM/Crit is though, but I will ask about it. 

I kinda felt like my neph randomly pulled this "dry weight" number out of the air and decided it was where I should be.

I am definitely with you - I want to be as active and informed of a patient as I can be.  That's one great thing about this site, learning from all you experienced pros who are kind enough to share your wisdom 

[RichardMEL]

Thanks so much Richard, that's exactly what I thought!!  If my BP isn't dropping and I'm not cramping than obviously I have extra fluid.  I don't know what BVM/BCM/Crit is though, but I will ask about it. 

oooh a cuddle from a hottie! I have got to help you out more often!!!! 

About the BVM/BCM/crit line - it's the same thing basically but different places/systems call it different things. Basically it's a process on the HD machine they can determine your fluid "refill" rate measured as a percentage. Around 90 is good.. Less than 90 suggests you're too dry (not refilling enough) and over say 92-93 means you're wet (still have too much fluid) as you're refilling very quickly. The refilling has to do with fluid going from the tissues into your blood once the HD takes fluid out.

Another thing I've had done is they pop you on these special scales that (somehow) measure the % of fluid in your body and that can also give a better indication as to how much you might be carrying, or not.

Good luck with it. Some docs don't like to be questioned by someone with a bit of understanding of the issues (they probably think by the axiom "a little bit of knowledge can be dangerous") but I have found when I talk to docs, nurses etc rationally and explain WHY I am asking for something they are usually pretty good about it and work WITH me to come to a consensus we're all happy with. At least if they say "no, we are going to do this" and give me reasonable reasons why - then I can accept that as a fair course of action. This is also why understanding of my situation and the issues involved is important I feel.

Let us know what happens!  

[hurlock1]

They have to set your dry weight. They take you down to below your actual dry weight and when you start to cramp they know that they have reached the bottom and they adjust accordingly.

[Maker]

I am still waiting to see my Doctor...my dialysis time isn't till 3 PM so it seems I've been missing him.  But I'm wondering if I should just insist he reduce my dry weight until I start cramping?  It seems crazy that I am trying to drink enough to "meet" this dry weight he has set, and the nurses only do what he says.  Thanks for your    Richard and Hurlock!  (I'm trying to find a use for every symbol there is, haha!)

[RichardMEL]

Maker I'd be less concerned about drinking to *make* the dry weight set than I would be about carrying extra fluid in the body. Something seems a bit wrong somewhere if you're coming in under your DW - ok you're still outputting urine, which is great, but I think it also means you have more fluid you can take out of your body (safely).

[okarol]

kidneysblowingchunks - Are you feeling better? I hope the cramping has gotten less.

[lizabee]

My weight fluctuates a lot, some days I am a little heavier than others and it took a while for my dry weight to be determined.  Whenever I do gain or lose a couple pounds, I try to let them know and they try to adjust as necessary.  I know that those cramps are a killer!  Good luck!

[kidneysblowingchunks]

kidneysblowingchunks - Are you feeling better? I hope the cramping has gotten less.

Hi,
Thanks for asking...
Yes, the cramps have subsided. I guess they found my dry weight the hard way.
I spoke to the Charge Nurse and got the matter taken care of. Those cramps are like being tazered from the inside

I still get cramps while I am not on Dialysis though. Especially when I wake up.

<At the risk of being smacked by the moderator for cross-posting from stupidest things said thread>
I told someone of my cramps, and they offered me a Slim-fast. They then told me that it's the equivalent of 7 bananas in potassium. I had to tell them of my restriction;)

[Maker]

So I finally cornered my neph today long enough to have a chat with him about my too high dry weight.  It's been well over 2 weeks since I've come in even within 1 kilo of that number 

He explained that by giving me saline before I leave to get me over that weight will help me keep my residual function and keep peeing. 

 Has anyone ever heard of this?  I mean, don't get me wrong, I am all about peeing 

[kidneysblowingchunks]

They did it again! I cramped on Monday.

Has anyone cramped after Dialysis? I tend to cramp during the first 24 hours afterward. Especially if I am just waking up.

There is a pattern starting to emerge at SPDC (They say it stands for Sarasota Physician's Dialysis Center, I say it stands for Severe Pain from Dialysis Cramps). One of the 3 "bays" tends to be more aggressive about achieving your dry weight than the others.

I had gained 1.8 kilograms, and I knew it was NOT fluids (if I had to pee, I would have proven it.)

My BP was high, and they seemed to want to bring it down by means of fluid removal.
I missed a dose or 2 of my meds.

I heard the best reply to the post-dialysis question of "How do you feel?"

"Washed Out"

[Lillupie]

YOu should just complain to a higher up. You should  never cramp.
Lisa

You all just confused the heck out of me and I have been on hemo since end of July.  We don't seem to get much choice in the decision on how much fluid is taken off.  I have had too much fluid taken off and gone home and had cramps for the rest of the day.  Not a lot of fun.

[kimcanada]

With me, cramping = passing my dry weight...

they are taking to much off you and should start slowly till they know what your dry weight is.  I HATE dry weight, gives other way way way to much control of your dialysis