low BP dizzy

[texasstyle]

I'm not sure what is going on here but my husband the last 2 weeks or so is dizzy all the time it seems especially when he bends over. His numbers right now are good, but his BP has been lowish. I'm wondering if he is filling w/ some water around the heart again. Mild edama in my  feet, but nothing too swollen. Average take off of fluid is about 12 lbs per session. I'm wondering if anyone else deals with low BP/dizziness a lot and what you do to help it. Thanks..

[boswife]

Do you really mean 12 lbs per session?  im figuring 1.2 kg's ? 

I do know lo blood pressure can be a cause of dizzy and if your taking off bunches, that very well coud be it?

[Stoday]

12 lb that's 5½ litres. I couldn't stand that; the most I've ever had taken off in one session is 3½litres, an experience I wouldn't want to repeat. No wonder he's getting KO'd.

Maybe he's a big bloke — if he's well over 200lb maybe he could stand it. I'm 170lb.

[greg10]

I'm not sure what is going on here but my husband the last 2 weeks or so is dizzy all the time it seems especially when he bends over. His numbers right now are good, but his BP has been lowish. I'm wondering if he is filling w/ some water around the heart again. Mild edama in my  feet, but nothing too swollen. Average take off of fluid is about 12 lbs per session. I'm wondering if anyone else deals with low BP/dizziness a lot and what you do to help it. Thanks..

I am sorry to hear that.  12 lb of fluid is 5.5 kg (or 5.5 liter) and is quite a lot.  Assuming this is HD and the patient is fairly heavy, say 220 lb (100 kg), the UF (ultrafiltration rate) limit should be 100 kg x 0.01 L /kg/hr or 1 liter /hr.  That means if the dialysis session is less than 5.5 hour, more likely 6+ hrs, you are already exceeding the patient's UF limit and the patient will suffer the consequences of too fast fluid removal.  If the patient is less than 100kg, the UF rate limit should be even lower.

Please try to limit salt and fluid intake and ask them to limit UF rate to 10 ml / kg /hr or below.

[texasstyle]

ohh..... I think I get it now, with that amount of fluid being removed in a normal time session, it would considered too fast and I'm starting to understand. I don't why this hit me all the sudden. Thanks Greg for the way you said it. Yes Boswife, it is 12 lbs. He thinks that's just a-ok...

[RichardMEL]

Pulling off too much fluid during a session can tend to lower BP during and at the end of the session leading to cramp and crash, but if his BP is low outside of D times, there's probably something else going on. Yes some fluid collecting around the heart and lungs may cause an issue like that if it's restricting the flow somehow, but it could also push it up (indeed my untrained mind would have thought too much fluid overload would raise BP, but everyone's different).

Really though 5+ kilos on between sessions is not good in anyone's language. Is his mom giving him 2L bottles of coke again??!! Honestly it's a worry that he seems to think that is an OK amount to put on.

Believe me, I *know* how difficult it is to restrict those fluids while on D (and for the record, once trained to do it, it's just as hard to remember to drink more now sometimes!). However just letting it collect up in the system puts extra strain on the heart and lungs and that's a stress an already taxed body full of toxins just doesn't need.

[Bruno]

Another way to lower his dizziness and get that 5 litre fluid removal goal per session down would be to increase the session frequency. My method is to never have more than one day between sessions, if I go two days I get into all sorts of trouble simply because my fluid removal goal becomes too high (I consider 3 litres plus excessive) and that means dizziness, low blood pressure, passing out and cramps.
I'm a big bloke as well, 108 kg (220 lbs plus).

[billmoria]

I am a big guy (314) and can stand taking off more liquid than most. However, 4 liters is the maximum my center will take off. I did take off 4.5 in a Davita in Florida but I will never do that again. My center will not let you go home with low BP. Feeling dizzy is a prime clue that you have low BP.
I am afraid that lowering you liquid intake is the only answer. No one like it but it is the plain truth.
I came in on Monday (I do M-W-F twilight) 5l over. I don't usually do that bad. We took off 4 and I was 1.1 over my dry weight. I was careful Tue and Wed and when I came in tonight I was 3l over. At the end of tonight I was .3 below my dry weight.
Genrally, the less you take off the better you feel and CONTROL  of INTAKE is the answer.

[texasstyle]

well, yesterday they took off 15 and yes it is on in between days. I think we need to make an appt. with heartdoc again. This gets tiring....