Why Do I Feel Nauseous and Lethargic After Dialysis?

Why Do I Feel Nauseous and Lethargic After Dialysis?

Answer: There are several reasons why patients may feel nauseated or very tired after a hemodialysis treatment. Feeling like this after dialysis makes a person not want to have another dialysis treatment and if a person starts skipping dialysis it can be even more dangerous and he will become sicker. When it does happen, it tends to get better in a few hours and definitely by the next day. If not, it may be a sign of another problem.

It is important to let the nurse or doctor know that you are having this problem. Some patients feel they shouldn't complain or that feeling bad after dialysis is normal. They keep feeling worse and worse and their life becomes miserable. The staff can often make certain adjustments that can dramatically improve your quality of life.

Many advances in the field of dialysis have led to a dramatic improvement in this problem. It can still however be quite bothersome for some patients. A better understanding of the reasons can help many patients help themselves in stopping this from happening. Below is a list of several of the reasons. A more detailed discussion of each reason follows.

*

Hypotension or low blood pressure
*

Allergic reaction
*

Infection
*

Dialysis "disequilibrium"
*

Severe anemia
*

Acetate dialysis treatments
*

Other

Hypotension or low blood pressure

Hypotension or low blood pressure is one of the most common causes, if not the most common cause, of nausea and tiredness after a dialysis treatment. During the dialysis treatment, fluid is usually removed to keep it from building up in the body. The fluid has accumulated slowly over the last 24 hours since the last dialysis treatment. This is not normal for the body. The more fluid that has to be removed, the greater the chance of a person feeling weak, tired and sick after dialysis. With the older dialysis machines, it was more difficult to remove the right amount of fluid and do it evenly over the entire dialysis treatment. The newer machines have small computers inside that allow the staff to set how much fluid should be removed each hour and this has improved the problem for many patients.

Drinking too much fluid between dialysis sessions

Probably the number one cause for hypotension, cramping, nausea and/or that tired feeling is gaining too much weight between dialysis treatments. Almost all of the weight gained between dialysis treatments is due to fluid. This may be fluid from food or just drinking a lot. Most food is mainly water. The body just cannot take having all that fluid removed in such a short period of time. Fortunately, this is something each person can control by making sure not to drink too much fluid between treatments. Each person is different and some people get sicker easier than others after a dialysis treatment. Pay attention to your body and you will be able to tell what your body can tolerate and help keep yourself feeling well most of the time.

Problems with "dry weight"

At the beginning of each dialysis treatment, a patient has his weight measured and this is compared to his "dry weight". The "dry weight" is the staff's best guess of the lowest weight after dialysis when a patient has no extra fluid in his body and still feels well. If at the end of dialysis, the weight falls below the dry weight a person will likely feel nauseated and tired. If a patient is feeling good and eating well he may gain weight and his "dry weight" should increase. However, the staff may not always know this is occurring and during dialysis the machine is programmed to remove fluid that will end up at your old "dry weight" which may be below your new "dry weight." This can cause hypotension, nausea or that tired feeling and cramping as well. Always remember to let the staff know if your appetite has been changing and you think you are losing or gaining weight.

Blood pressure medications

Many patients on dialysis have high blood pressure. Usually, the blood pressure falls during the dialysis treatment so most patients are told not to take their blood pressure medicines before dialysis. This is because as the medicine starts working and lowering the blood pressure and the machine is removing fluid and lowering the blood pressure, the blood pressure may go too low and you will again start to feel sick. Some people have very high blood pressure and may need to take medicine before dialysis but for most people they should not. Make sure to let your doctor know if you are taking your blood pressure medicines before dialysis and then feeling sick at the end of a treatment. Do not stop taking your blood pressure medications without first talking to your doctor.

Allergic reaction

Some people may have an allergic reaction to the dialyzer and this can cause low blood pressure, nausea and an ill feeling. Some reactions are more severe than others and are easier to notice. The less severe reactions are more difficult to detect and may cause ill feelings. If this is the case, using a different type of dialyzer can solve the problem. Again, the key is to let the staff know. Usually, they will check to see if the problem is related to fluid first but if it doesn't look like fluid is the problem then it might be the dialyzer.

Infection

Infection can cause low blood pressure, nausea and a tired feeling. This can happen if there is a new infection that happens during dialysis or if there is a chronic infection that affects the way the body can tolerate the dialysis session. A new acute infection that occurs during dialysis is usually easier to detect because there is almost always a fever and the person feels really sick even before the dialysis ends. A chronic infection can make you feel sick most of the time but also may make low pressure and sickness happen easier after dialysis. The fever may be low or may not occur while at dialysis.

Dialysis "disequilibrium"

This is a term used for problems that occur when too much of the poisons that build up, like urea and creatinine, are removed from the body very quickly. In a way, this happens during each dialysis session when the kidney machine is trying to do in four hours what the body would normally do in two days. Usually, the removal of these substances that build up between dialysis is fairly well tolerated. However, if these substances build up to higher levels over four or five days or more then removing them in just four hours can cause a person to feel sick with nausea, weakness, headaches and even seizures. This is more likely to happen when a person misses a dialysis treatment or several treatments. For many people who have missed dialysis, especially more than one, the treatment may have to be modified to remove less urea at a time (lower blood flow) and/or to have back to back short treatments two to three hours a day for three days, to slowly catch up. This does not happen often to patients on chronic dialysis unless they miss several treatments. This is more common in patients with acute kidney failure having dialysis in the hospital.

Severe anemia

Severe anemia can lead to low blood pressure and weakness. This can be magnified by the dialysis treatment. Most patients have their hemoglobin levels followed closely so this is not as much of a problem as it used to be. If you continue to feel weak after the dialysis and into the next day, then it may not be the dialysis but something else like anemia or an infection.

Acetate dialysis treatments

Several years ago, most dialysis treatments used an acetate solution. This is not used much any more and has been replaced by bicarbonate solutions. The acetate solution was used to help treat and prevent acidosis but was more likely to cause hypotension, headaches and a sick feeling. For many years, there was no other option. Now with bicarbonate dialysate solutions, most people seem to do better during the dialysis treatment.

Other

As in everything else in life, there may always be some other reason why things happen. There may be reasons we don't even know of yet. The most important point is to let the dialysis team know what is happening so they can check into the more common reasons listed above. With teamwork, the cause can usually be determined and the problem solved or greatly improved.

Answer provided by Keith Norris, MD. Dr. Norris is Professor and Executive Vice Chair of Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science and the University of California, Los Angeles (UCLA). He serves on the AAKP Board of Directors and the AAKP Medical Advisory Board and is an AAKP Life Member.

The Dear Doctor column provides readers with an opportunity to submit renal related health questions to healthcare professionals who specialize in the area of concern. The answers are not to be construed as a diagnosis and therefore, altercations in current healthcare should not occur until the patient's physician is consulted.

This article originally appeared in aakpRENALIFE, July 2002 Volume 18 Number 1.

http://www.aakp.org/aakp-library/feel-nauseaus-and-lethargic/