Third Spacing - What the heck is that?????

[looneytunes]

This may be a term that is local to our area but our PD nurse has told us that she believes hubby is a "third spacer".  This was in connection to a problem we are having in that he can get a great pull from using green or red solutions on the cycler but his weight continues to climb.  He is not eating enough (has very little appetite) to be gaining real weight.  His ankles calves and thighs are swollen with fluid even in the morning when he gets up after a 1700 ml UF.  It just isn't coming off.  She said that some people will hold fluid in their tissues that doesn't get released into their vascular system and thus the big fluid pulls can actually dehydrate them though they are still carrying a lot of fluid.   So far, she and the neph have not given us any solutions to this though this has been going on for about a month.    His BPs are good though there are times that they suggest dehydration by a 40 to 50 point spread in the sitting vs. standing top number when we try to pull fluid off. 

Has anyone else run into this?  What can we do about it?  I feel like I have learned more from the IHD folks than our med team. 

[Hanify]

Oh no Looney - it doesn't sound too good.  That haemo day might be looming closer.  I haven't heard of that problem before sorry.

[bege]

   Hi third spacing is a termj that means that the fluid is stuck out in the tissue, like in his legs. It usually isn't just in the legs but can be any where in the tissue.  It happens a lot after ajor surgery, when they have used a large amount of iv fluids.  with normal kidney functions patients will normally pee it off, which we can't   bege

[looneytunes]

Thanks Hanify and Bege for the replies.  We just got home from seeing our neph and we got a real education in this.  Bege...you were absolutely right.  The issue now is what to do about it. 

Niether PD nor Hemo will pull this fluid off hubby.  It is caused mostly by his low albumin level.  Evidently albumin helps bond fluids into the vascular system where it can be removed through dialysis.  However, since hubbys albumin is so low and he is still losing it in his residual urine function, there isn't enough in his blood to keep the fluid passing into the vascular system.  He doesn't want to use any treatment that would negate or stop his residual kidney function as this is helping in keeping his clearances adequate and he is barely in the adequate range now for the 1st time in 3 months.  The neph is going to try a process where albumin is infused into his dialysate and have this solution dwell 4 hours to see if that will pull more fluid from his tissues into the vascular system and thus allow dialysis to remove it. 

When I asked (and I couldn't stop myself from asking  ) what happens if this doesn't work...I got one of those "I wish you hadn't asked"  ::)looks.  Then a short (very short) dialogue about the fluid in the tissues will eventually get into the veins and arteries but it most likely would be a sudden thing and we would need to watch his BP carefully as when this happens, we may need some urgent care.   But, apparently as long as he is getting adequate clearances with dialysis and as long as his BP doesn't spike up, we just watch and wait while he continues to balloon. 

So, it sounds like another month of waiting for whatever is going to happen...to happen! 

[Hanify]

How low is his albumin.  I struggle with mine too.  Is he on protein supplements?

[looneytunes]

His most recent labs (last week), albumin is 2.2   We have tried protien supplements and currently are still pushing them down him though the neph today said it really wouldn't help since he keeps losing it in his urine.  But if he drops below 2.0 they will take him off PD.....so...will keep pushing protien to hopefully keep him off of hemo as long as we can.  He eats Zone bars and I mix protien powder into his food. 

[Hanify]

Oh bummer.  Mine is 2.9 and I thought I was bad.  It's so hard to get it to improve though.  I'm drinking two protein drinks a day and tryiing to eat meat every day - are there any vegetarians on dialysis?  How would they cope?

[Lillupie]

I asked my own nurse this, and she told me those who are vegetarian are not allowed to do PD. THey have to go on hemo. It is even harder on PD to keep your protein levels up.

Lisa

Oh bummer.  Mine is 2.9 and I thought I was bad.  It's so hard to get it to improve though.  I'm drinking two protein drinks a day and tryiing to eat meat every day - are there any vegetarians on dialysis?  How would they cope?

[looneytunes]

Well...we are now experiencing the fluid coming back out of the tissues into his bloodstream.  His BP is up but not to the "danger" level.  We have been using 12,000 ml of greens on his cycler at night to help pull off the fluid as it comes back into his vascular system.  He seems to be feeling some better and has lost 8 lbs in the past 2 days.  But...those drain bags are HEAVY in the morning!   

[billybags]

looneytunes, Hubby went to the unit to-day, only because I was worried, like you do do. He is also putting weight on. He is using all greens and an extraneal at night. OK so he has only been back on CAPD nearly 2 weeks and since he came off hemo his weight has gone from 72.5 to 79.70  It may not seem alot, but I can remember when his weight was 84 with the e-coli virus and he was well over loaded and so very ill, he could not breath.At the unit he was told to keep using greens and it would eventually go down. I will now check his albumin, it is 33 our levels are ok if between 35 and 50. Thanks for the tip. Keep your eye on it.

[looneytunes]

BB, aren't we the worriers!  But if we left the worrying up to the med teams we wouldn't have them around to worry about any more!     Hubbys weight went down another pound today and his head is starting to look normal (as opposed to swollen).  Still a lot of fluid in his back, upper arms, calves and thighs but not as bad as it was a week ago.  This morning his BP showed signs of dehydration and he felt weak and shaky most of today so we are backing off of the greens for at least tonight.   If his BP is better in the morning, will try to do greens again tomorrow.  It sounds like the albumin levels are just off by the decimals between the USA and UK.  Target for us here is between 3.5 and 5.0.

Here's hoping both of them do much better over the next couple of weeks!   

[girliekick]

some times i will use a combination of green and red or even red and yellow. If i feel that is what i need.  just a suggestion to keep pulling, and may keep him from dehydration. Sounds so much better,though. I was getting worried
girl

[looneytunes]

Hubby was a little better today and is maintaining the weight loss he's had over the past few days.  Last night he had a negative UF drain but no weight gain.  So we are going to do a green and yellow tonite and if he is still feeling decent tomorrow will go back to 2 greens tomorrow night and try to pull some more off.  Right now we figure he has about 15 extra pounds of fluid on him so we have a way to go.   Thanks for the replies...we all learn together!