My First Crash

[Stoday]

It had to happen sooner or later. I've often wondered what a crash was like from the mentions on IHD. Now I know because it happened to me on tonight's twilight session.

I guess I had been a bit naughty over the weekend. I blame it on the 1995 Pichon Lalande. Anyway, the machine was set up to take off 3.7 liters. After 2½ hours, I was dozing away when it appeared to start raining in the unit. My head was a bit tender too and I certainly felt unwell. I cried out for a nurse, who came over. I perceived a fleeting look of "has he shit himself?" when she saw that my blood pressure was way down. Took me a full hour to recover.

At the end of the session I said that maybe we ought to revise my dry weight target...

[tyefly]

 I know I would probably crash if I was taking off 3.7L.....    scary..... I hate the crash.....    I certainly did that a few times my self when I was in center......   Hope you have a better time next time

[jbrock]

"The Crash" scares the dickens out of me....just the thought!!

Is this common?   I assume they know how to handle these things when it occurs?

Joy

[Rerun]

"The Crash" scares the dickens out of me....just the thought!!

Is this common?   I assume they know how to handle these things when it occurs?

Joy

Yeah, they give you some saline and you come out of it.  Cramps are what I like to avoid.

[Riki]

I've never cramped, but I have crashed, to the point of losing consciousness several times.  Yes, they know what to do, and yes, it's common, and yes, you feel like crap for a while afterwards.

holy crap, 3.7 litres? really? My dry weight is 100.5kgs, and I can't take off more than 3 litres, no matter what my weight is.  I think that most of us have a limit, and no matter how much fluid you're holding, if you go over that limit, a crash is usually imminent.  The biggest thing is knowing your limit

[cloud393]

Oh the cramps are horrible.  When I was training for NxStage my whole body cramped one day.  Oh did I think that was the end.  None of my labor and deliveries were so bad.  I just about blacked out in center once.  That was awful scary too.  Same as you, it was the blood pressure.  Little saline and ok but it sure makes you feel baaaadddd for awhile.  Sorry you had to experience the crash but like you said, you knew it would happen sooner or later.  Take care!

[needlephobic]

Got one for you 2 crashes in one setting. Stupid tech took too much off of me and i complained about the cramps every time i went in all they said was we need to change your dry weight but never did it took about 2 months and the 2 crashes for they got a clue. the day of the crashes i got a cramp in my foot and was setting up putting weight on my foot and ol charlie horse hit me so i was massageing my leg and out i went came to didn't really know where i was at and crashed again next thing i know tech was asking me if i was still with them and once blood pressure got back to normal they changed my dry weight. They had to wait untill something bad happened to do anything about it 

[galvo]

3.7 liters!!! No! No! No! Through painful trial and error I have learnt that anyhere over 2.8 means pain and suffering.

[Riki]

3.7 liters!!! No! No! No! Through painful trial and error I have learnt that anyhere over 2.8 means pain and suffering.

Everyone is different, though... I used to be able to go to 3.2, but I did that one day, and the bp bottomed out.  I could feel it coming so I got the attention of one of the nurses, and she gave me some saline before I actually passed out.

[Adrian7]

Horses for courses,  had my 1st crash today also, set to take 3.4ltr. though 4+ has been managed previously. Been going for 3 1/2 months and I think I've had 2 sessions without cramps. blood sugars drop to under 3 regularly also.

[YLGuy]

They pulled 3.8 off of me today. No cramps/no crash. (dry weight is 84)

[Tracy]

Yes, it is strange.  Sometimes, I can pull 3.8 with no problems and pull 2.3 with low bp and almost passing out.  I am a strange duck I guess.   

[Restorer]

My dry weight's around 50 Kg. I've gone as high as 3.5 liters in the hospital while very overloaded and felt just fine, but I've almost crashed on 3.2 in-center. I could probably go higher if I totally skipped my BP meds in the morning. I guess everyone's different.

[KICKSTART]

Do none of you set a BVM or check your crit line?  Feeling funny? check your bp ! Ive managed to save myself lots of times by doing these things 

[Riki]

I'm not able to see the machine, so I don't know what any of the readings are.. I don't know if there's a way to measure BVM on the machine.. Also, due to listening in on a conversation between the Neph and the nurses, I now know what kt/v is, cuz I never understood it

[ChickenLittle56]

Restorer, you have the right idea, I've always been told not to take my BP meds before D. I take mine before I go to bed and after D treatment so my bp doesn't crash.

[galvo]

My BP is lovely.

[KICKSTART]

My BP is lovely.

    Can i have it ?

[kamar55]

I've crashed many times and I hate it. So now whenever the alarm goes off that my bp is too low, I get a hypertonic so I don't crash. It happened again yesterday when my bp dropped to 70/30. I used to wait until I "saw stars' to ask for hypertonic, but by then it was usually too late and I passed out. Came to hooked up to oxygen and with a bloody tongue. Seems I bite my tongue hard when I pass out. No fun.....

[rocker]

It's not so much volume, but rate.  Taking off 4-5l is probably no big deal if done over 8 hours.

I believe I've read on Bill P's blog that most adults can transport from interstitial fluid (outside the bloodstream) at about 400 ml/hr, so at a rate of 400 you should be completely stable until you hit your dry weight.  (and likely a bit beyond)

But squeezing so many patients in-center, dialysis has to be hard and fast.   

Another reason to be at home if you can...there's no one waiting for the chair.  You can go longer if you need to.  I also will do my own profiling....start him at 1.5, go down to 1.0 after an hour, down to 0.8 after a bit longer.  I've never been specifically authorized to do that, but I know when he can take a fast draw and when he can't.

We've had two near-crashes in over a year of home dialysis (caught as pressure started dropping and stopped with saline infusion) and no real cramping that he's mentioned.

[Riki]

I would not want to be on dialysis for 8 hours.  4 hours is long enough as it is.  I don't think I could stay still for 8 hours like I have to for 4 hours now.  I think that having to sit on the machine for 8 hours would diminish what's left of my sanity.  I think I'll risk the occasional crash.

[Bruno]

The one thing the original post leaves out is the time. Because the that is what what nominates the safety factor you should be looking for in each session. I look for a UF rate of 400 maximum. Over 5 hours that allows me a goal of 2 litres and has given me no problems to date. I'm 110 kg dry weight.
The big argument against short sessions no matter how inconvenient they are is the amount of stress you can put your body under.

[Stoday]

The 3.7 liters was to be taken off in 3½ hours. I've has 3 liters off in the 3½ hours without any problems, so that suggests that my limit is somewhere between the two.

[greg10]

The 3.7 liters was to be taken off in 3½ hours. I've has 3 liters off in the 3½ hours without any problems, so that suggests that my limit is somewhere between the two.

The number is 10 ml / hr / kg.
If you are 100 kg, that is 1000 ml/hr limit for ultrafiltration (UF).  This is especially true if you have had vascular problems such as congestive heart failure and heart attacks.  You are just taking chances with cardiovascular morbidity the more often you crash.  Take care.

Rapid fluid removal during dialysis is associated with cardiovascular morbidity
http://ihatedialysis.com/forum/index.php?topic=20596.msg343443#msg343443

[Stoday]

Before I got ill I was 111 kg. Now I'm 78 kg.

Thanks for the link, Greg. Looks like I'll have to watch my fluids even closer.