Almost fainted?!?!

[AaishaDar]

Today was a very scary dialysis session for me at least. Today went to the dialysis center 630ish feeling normal just sleepy because its so early. Go on the machine then two hours later i feel short of breath. This is normal so i just lifted my head up to check my blood pressure it was on the lower side not unusual. It has been low for sometime now. As i lay back down I feel extremely dizzy. And everything seemed fuzzy. Ive never experienced this before. My arms and legs they felt so weak i couldnt lift them and i went pale in the face the tech tells me. They lay my head down and give me oxygen. I tried tp stay calm but i could feel my heart racing also had lots of nausea. I didnt even pull a full two kilos and i started to feel like that. Is this common for patients? Feeling like they are going to faint? Im scared to go to my next treatment... the nurse wants me to do any extra treatment because my bp has been dropping and I havent been able to remove much fluid. Have any of you fainted before? What happens and how do you prevent feeling like that.

[AaishaDar]

My bp dropped to 69/49 and i had to stay after my session was over because it wouldnt go back up.

[Michael Murphy]

I have had this problem lately. It has been caused by fluctuating dry weight, last year I had a major heart attack.  My heart capacity to pump blood has been drastically reduced.  To improve things I joined a cardiac rehab program.  Began to feel better but I think I began to loose weight. Dialysys brought me to my stated dry weight but since I weighed less I was gaining more and more fluid.
Now I have to monitor my dry weight and adjust it for my diet,  I f you BP is getting low ask for oxygen it helps.  Several times as my BP dropped the nurse slapped a oxygen line on me and I felt better.

[AaishaDar]

Its really odd odd to me that my bp is low and i am fluid overloaded. My parents think I lpst weight and when trying to reach my dry weight its nearly impossible. The oxygen did help. Im home but I feel short of breath its like im having a panic attack almost. Im a pretty small person 5ft 83 pounds.  I feel like my appetite is okay for someone who has chronic kidney disease because I dont feel hungry most of the time.

[iolaire]

The symptoms you repeatedly ask about sound as like symptoms of taking off to much water. Could you have gained weight and not realized it?  Maybe measure your intake of liquids and output of liquids for a few days to get a accurate gage of your gain just to be sure?

Also does your small size allow significantly less liquid removal?  I've heard that large people can take off much more liquid that me at ~90 kg.  If the weight gain is real you are probably stuck minimizing the gain so as to have better dialysis sessions and quality of life.

[GA_DAWG]

I agree it sounds like you may have actually gained weight and need your dry weight adjusted. That was what they did after I went through similar things. The one thing I remember is if I suddenly feel hot or begin to sweat, I need to get someone's attention and have them return fluid.

[AaishaDar]

If i did gain weight which I hope I did then please explain when i reach lets say 39 kg dry weight 38 why am i still feeling fluid overloaded? This is why i refuse to believe i did gain.

[Charlie B53]

I suggest that you see your Primary Care Physican for a serious check-up along with full labs.  PCP and Dialysis Clinics do not run all the same Lab tests.  It is possible that you may have some other issue, NOT related to your Dialysis that may be contributing to your symptoms.  Getting checked out may rule out many other possible concerns.

Determining individual dry weight is not always an easy thing as we do not all respond the same to a kilo of two of water either over or under our 'dry weight'

I myself am very sensitive if Dialysis takes off even one extra kilo.  But I feel simply fine a couple of K's over.  A couple of my Nurses feel my ankles and tell me that I am over but I don't feel it and I am perfectly am happy with my ankles as they are no longer huge and leaking, they look fine.  All in all I am far better than this time 5 years ago.

[Tío Riñon]

My father had a similar incident a few weeks ago.  He was in the middle of his dialysis run and he passed out.  He has no recall of what happened, but the nurse declared him non-responsive and the Nephrologist instructed her to send him to the ER via ambulance.  The initial diagnosis was Syncope (http://www.heart.org/HEARTORG/Conditions/Arrhythmia/SymptomsDiagnosisMonitoringofArrhythmia/Syncope-Fainting_UCM_430006_Article.jsp), a medical term for fainting or passing out.  This can be an indication of blood pressure and/or heart problems. 

They ran some blood tests and thought that there were signs of elevated chemical levels related to a possible heart attack.  He eventually was admitted for further observation during which they ran additional tests including an Echocardiogram, wearing a Holter Monitor (for the heart), and doing a CT Scan.  After all that, a pulmonary embolism was discovered.  He was admitted and kept for a few days while Heparin and Warfarin were administered to dissolve the clot.  Also, he was carefully monitored during his dialysis runs in the hospital.

Follow-up is looking good.  So CharlieB53's advice is sound to talk to your Primary Care Physician about this matter and perhaps include your Nephrologist as well.  Good luck!

[kickingandscreaming]

I too had syncope recently and fainted 7 times in 2 days.  Wrecked my back in the falls.  Turned out I had heart block and needed a pacemaker.  Since then, I've had no further incidents (thank heavens).

[lulu836]

This is probably old news to most of you but new to me...........I have found I can influence my BP by raising or lowering my feet in the treatment chair.  I ask the RN to turn the machine so I can see the numbers.  When the BP gets too low, I raise my feet.  When it get too high, I lower them.  I can influence the resulting numbers by 20 points systolic and 15 points diastolic.  I write down every drop of fluid intake and have scales that measure weight in kg.  Having those scales prevent me from any big surprises on dialysis day. 

[kristina]

This is probably old news to most of you but new to me...........I have found I can influence my BP by raising or lowering my feet in the treatment chair.  I ask the RN to turn the machine so I can see the numbers.  When the BP gets too low, I raise my feet.  When it get too high, I lower them.  I can influence the resulting numbers by 20 points systolic and 15 points diastolic.  I write down every drop of fluid intake and have scales that measure weight in kg.  Having those scales prevent me from any big surprises on dialysis day. 

Well done. Lulu!
I do exactly the same and have started my dialysis-diary from the moment my first dialysis-treatment started. Into my dialysis-diary I write down my daily weight, my daily liquid- input, medicines, BP etc., I also note down blood-test-results, plus occasionally I check-up my (slowly diminishing) output as well .
It all helps me to survive dialysis-treatments as well as can be done plus it keeps my body as happy as it can be under dialysis-circumstances.
Best wishes and good luck from Kristina.
P.S. At first the whole writing-down-discipline seems like "doing" a "job", but after a while it becomes second nature and helps a lot!

[Charlie B53]

Currently my dry weight is set at 102K.  Most treatment days I weigh out less than that, often as low as 101.2 and I am still fine but any lower and my legs will cramp later at home during my nap and again a few times during the night.  Each time I have to get up and pace the floor until it resolves.

Sometimes, but not always, during treatment I can have a warning that I am getting too dry, my head will break out in a sweat that's when I call my Tech or the Nurse, tell them what's happening and they will turn off the fluid removal.

You could still be accumulating fluid in your lungs, raising your weight and contributing to breathing difficulty.  The Clinic will see that weight as simple water weight needing to be removed and this will lower your circulating volume too much, causing lowered BP's.  It can be very difficult to know the difference unless you get enough fluid in your lungs that someone with a good 'ear' can hear the difference in your breathing while using the stethoscope.

[GA_DAWG]

Charlie is exactly right. If you start to sweat and feel dizzy, you should call the nurse quickly. It will not be long before you pass out. Your dry weight may be too low, and also, the speed with which they take off fluid can effect it. I had this problem when I started dialysis, and passed out a couple of times. always towards the end. My neph changed the rate the machine takes fluid off and changed my dry weight. That was also the point where I realized I needed to learn a lot more about what was going on and started asking questions.

[Paul]

I find I faint if the needle touches the wall of the fistula. You can usually tell when this happens with the "suck"* needle because the tube feels like it is juddering. No idea how to tell if the "put back"* needle is touching the wall

I have found I can influence my BP by raising or lowering my feet in the treatment chair.

I also works (if your chair will allow it) if you lower your head. I sometimes have to do both, and occasionally end up with my feet pointing at the ceiling and my head pointing at the floor, keeping very still, terrified that the slightest movement will make me slide off the bed, head first!



* I really must learn the proper technical terms for these things!

[kitkatz]

I work the opposite  with the blood pressure in the chair.  They have to sit me up to get the BP to come up, I have even had to stand up to get my BP to come up to a normal range.  If they lay me back I will have a low BP get even lower.  They think I am weird.

[GA_DAWG]

They tell me I have weird BP also. At the end, it is higher standing than sitting. While I am running, the chairs being what they are, recline on their own if you fall asleep. My BP drops until I pull the chair back to upright position. I have had many very restful naps interrupted by a tech worried about my BP.

[Michael Murphy]

Cas posted a link to a ultra filtration calculator.  It takes weight, fluid to be removed, and session length and calculates if too muc is being removed.  To get 2 kilos off safely for a 83 pound patient would take around 6 hours.  At 132 kilos at 4.5 hours I can safely take off 5.8 kilos.   http://www.homedialysis.org/home-dialysis-basics/tools-and-links

[SweetyPie]

I have gained weight now at 86 but ita still the same situation trying to get to my dry weight. Being after the weekend I was 43 kilos and had to reach 40 kilos. The tech planned to take 2.2 not even all of my fluid. I felt really hot the whole treatment even in the beginning then towards the end started to get super sleeply felt sort of faintish. I told the nurse and she added saline I told her not to add alot because I already had a lot of fluid on me. But she had to add more because my bp dropped down 70/40. Even though i still have fluid on me I feel light headed.

[Michael Murphy]

Check the web page to remove two kilos from you would require a 6 hour session. Are you going to a Fresenius clinic there is a new policy requiring them to remove only what the web page says is safe.

[SweetyPie]

Not sure what a fresnius clinic is but the clinic doesnt allow more than 3 kilos to be taken off. My techs know me too well and dont try to do more than 2.5 because o get extremely sick and pale in the face.

[lulu836]

I have found I can influence my BP by raising or lowering my feet in the treatment chair.

It also works (if your chair will allow it) if you lower your head. I sometimes have to do both, and occasionally end up with my feet pointing at the ceiling and my head pointing at the floor, keeping very still, terrified that the slightest movement will make me slide off the bed, head first!

Yep.......Trendelenburg Position.........hate it.   That's the very thing that led me to the "guinea pig" adventure on myself to find a way to avoid that.

[Paul]

Not sure what a fresnius clinic is

Fresnius is the corporate name of a German company that runs Dialysis clinics all over the world. Last count, they were the biggest such company in the world.