Vomiting and dizziness

[frankswife]

Hi all. Frank has been on in center hemo for 2 months now. The last several times he was on the machine, he became very nauseous and he vomited. He was also quite dizzy. He has vomited 3 or 4 times at home the last few weeks too. The vomiting episodes are most often preceded by a major coughing fit. Today though sent me over the edge. He calls me after dialysis to say he just threw up and was dizzy and couldnt drive. He told me he tried to tell the nurse he didnt feel right while she was taking him off and she said, "well, your bp is ok, so..." and let him stumble out the door. He sat in his truck for 10 minutes before he could even call me. WTF? Pardon my French, but I'm really upset. I'm not trying to blame anyone, but this particular nurse is an on-call substitute and she can never seem to get the needles in his fistula and has to use the catheter. Frank wont speak up because he doesn't want to cause trouble. If I have to go in there he'll probably get kicked out of the center because I am not going to be very nice. So, first, what could the vomiting and dizziness be caused by? His neph thought maybe his dry weight was too low so they bumped it up a but and it happened again. I am very worried. Second, I'm beginning to suspect that the failure to use the fistula has less to do with the fistula's maturity and more to do with nursing ineptitude. Should I talk to his neph? Im worried he might take the nurses' sides.

[sullidog]

Unfortunetly techs and nurses seem to think if a person's bp is ok then they should be fine, believe me I fight this battle all the time. Just because the bp is fine doesn't make the person feel fine. Sounds like a fluid issue to me and I'd talk to his neph. Nurses and techs seem to think they know how a person should feel and it's just an on going fight, but I won't let them win.

[Sydnee]

That would make me so mad.
when Ed was doing in center he felt the same way as Frank does. It bothered me so much that "he wouldn't stand up for himself" it was frustrating to me.

Not sure what would cause his problems. I would talk to the head nurse and the neph if that had happened to Ed. if that one nurse or tech is the problem see if you can get someone else to help Frank.
Oh they had to bump up Ed's dry weight 3 times before it was right.
Sorry I can't help more.

[Joe]

My first impression was that his BP was low. The vomiting and dizziness and passing out are prime indicators of a low BP. Are you sure the nurse read it right? Other than that, I don't know what to look at.

Good luck!

[frankswife]

Thanks for your input, guys. I'm thinking its a fluid thing too and they'll have to bump up again. I think what may be happening is that he's gaining body weight since his appetite is coming roaring back and he's eating like a little piggie and they've got his dry weight too low now. Does that make sense to you guys?

[Grumpy-1]

If the dry weight is too low the result is dehydration.  That can cause the dizziness and lightheartedness.  I'm not sure on the throwing up.  Grumpy

[BobN]

Definitely makes sense.  Any gain or loss of weight should cause a dry weight adjustment.  Based on the symptoms you're describing, I'm betting that's what it is.

Best wishes.

[okarol]

In our experience we found that even though BP is ok you could be losing some essential electrolytes and salts if too much fluid is taken off. If he is a steady weight and not retaining fluids between treatments they should reset the machine to take of the minimal, or NO, fluid. Is he still urinating? If so then they should not take the typical amount of fluid. Jenna experienced this often and I had to get the charge nurse and stand by while she gave the tech permission to reset the default setting. On bad days Jenna was nauseous, headachey and had to go to bed after drinking a bottle of Gatorade. I would ask the charge nurse or neph, sooner than later.

[frankswife]

Okarol, he is still urinating (alot). I'm going to talk to the head nurse and his neph (if I see him) on Thursday. Frank is pretty sick tonite, I'm worried he's in diabetic ketoacidosis but he says no (he's been through it 4 times before). He wont go to the ER to get checked out. He does have an appt with his primary at 8 am tomorrow. He did dialysis today, he's been coughing like crazy and threw up again even though he said they bumped up his dry weight again. I'll see how he feels in a couple hours.

[lmunchkin]

FW, I remember my husband when he went in-center was always dizzy and vomiting and had lots of low BP's and was drained all the time.  I couldnt stand seeing him like that.  With NxStage, he does alot of that coughing you talk about and at times get nausea, but I truly believe it could be a combo of things.  Maybe too much fluid being removed or definately toxins.  Toxins can reak havoc on the body making people very sick!

I think it is just one of the things that goes along with ESRD.  You could probably take some sort of medicine for it, but John just lives with it from time to time.

It would be nice if you could do D at home, but I know that is not always feasible for some people.

Good Luck & God Bless,
lmunchkin

[sullidog]

Fw,
I still urinate a lot, I find with me, even though they put me at minimum, I was still getting sick, so what they do is give me flushes every hour of 300 ccs. Tech's don't like to do this so this is something if this is what needs to be done you and him will need to to have the neph put in a special order to have this done.