Blood Pressure Crisis

[SierraJim]

Last 3 or 4 times during my dialysis sessions I've nearly passed out.  My BP has gone down to as low as 60 over 30.  Today it took 1.5 hours to bring it back up.  I left the unit with a BP of 105 over 60.  I feel rotten.  This is getting tedious.  Has this happened to anyone else?  How have you dealt with it?  I was told that my fluids were out of control, but I am pretty diligent at not drinking more than a quart a day.  I ordered one of those "digistraws" that measure the amount of fluid that goes in and puts it on a memory chip.  I guess the answer is just to be more vigilant about fluids.  Anybody have any advice?

Best regards from Jim

[jbeany]

Are you on any blood pressure meds?  Your intro says Oct 1 for a start date, so it's possible the dialysis treatment has just lowered your pressure over time. 
I've had to go off 3 different bp meds since I started in Dec.  I went off two of them the first few weeks, but after the first two months, I started having low bp and crashes all the time.  The neph dropped another med, and now I'm back to having better dialysis sessions. 

What's your blood pressure when you are home?  Is it low when you aren't having dialysis?  If your fluid gains are low, they shouldn't be causing bp problems.  If it's low all the time, the neph should be able to do something about it.

[SierraJim]

Thank you jbeany for your post.  To answer your questions, I only have this problem while I'm having dialysis.  At home and elsewhere my bp is consistently around 130/80.  Neph dropped all my bp meds.  I'll hopefully be talking to him again sometime next week.  This situation has got to change!

[BigSky]

Have a crit-line machine put on and check to see how the fluid is coming off.  This will show if you have gained weight or not and help determine if your dry weight is the problem.

Weight gain is not uncommon in patients because of lack of activity in their life compared to predialysis days.

One should request this be done at least once a month, more if they are having problems.

[Sluff]

Jim I hope things are improving with the low blood pressure. Have you tried anything different?

[billoggblog]

I know, for some strange reason my unit likes to keep patients dry weight as low as possible. This may look good on paper but, you still need to feel fine in yourself.  What you need to do is try a establish an acceptable dry weight, do you have any fluid retention in your ankles, try pinching some skin on the back of your hand, does the skin go back to normal quickly, or is it quite slow, if it's fast then you are maybe too dry.
I also suffered with low BP (70/35) while on dialysis, it took me a long time to persuade them to increase my dry weight, but eventually they allowed me to increase it by .6 and this made all the difference.  Maybe this is not the cause in your case, but it certainly sounds to me as if it's got something to do with your weight.
I hope you find an answer soon, because I know just how bad you feel with really low BP.
Good luck, and remember doctors aren't ALWAYS right.

Bill.

[thegrammalady]

as it was explained to me, my pressure was dropping too low because they were pushing my dry weight. ie- taking more fluid thann necessary. the dr put a stop to that i'm losing weight (on purpose) and the dr is very cautious about lowering my dry weight because he doesn't want to cause dehydration. i have my fluids well under control. a small weight gain doesn't necessarily mean too much fluid. everyone is different. nor does as i was told on friday, a weight loss mean i'm not eating enough protine. lets get real here.

[RichardMEL]

I was thinking it could be that Jim's dry weight is too low. I found I had near crashes and low BP until my dry weight was upped by about a kilo. Now the BP is a tad high so we're bringing it down by 0.2 to see how that goes for a bit. It definitely was better when I had a higher dry weight... so perhaps Jim should discuss that with his neph/dialysis staff too...

good luck Jim.. those low BP's are scary, speciallly with the way it makes you feel!

[renal30yrs]

I tried to stay half a kilo above my dry weight and yet my pressure never goes up.  I typically start dialysis around 87/45.

[SierraJim]

First of all, my heart goes out to the Halcomb family.  During the very short time I was associated with Bill he had a profound effect on my life.  I found a new family because of him, and I'll always be grateful to him for his forsight and courage in starting this site.

Thanks everyone for your replies.  I'm going to start solving this problem with more knowledge -- knowledge I could not have gotten anywhere else. 

Jim

[okarol]

Hi Jim,
Jenna kept having big drops in BP and would leave the dialysis center feeling wiped out. It would affect her for the next 12 hours. She would sometimes be at her dry weight, or just over, and I would have to absolutely insist that they not remove any fluid. Sometimes they would take off fluid anyway, then have to add saline to bring her weight back up. Since she was still urinating a lot, she was not retaining fluids, the default on the machine had to be manually over-ridden (which practically took an act of Congress.) It appears that she would gain a little weight (not fluid, just from normal eating and mild fluctuations, which is normal for a 118 lb. 21 year old female) and the machine just could not cope with it. The best we could do was insist on no fluid removal, then load her up with Gatorade immediately following dialysis, as that would help with her BP and electrolights. I don't know what we would have done long term, as it was a fight everytime to keep them on top of her dry weight, and to re-evaluate that number each session!
Hope you get some solution to this,
Karol