Sudden BP drops during HemoDialysis

[overtaker]

Hi all

I am wondering if anyone ever experienced a sudden BP drops during Hemodialysis, my mother had one serious episode where her BP systolic dropped to 56 during HD and she lost consciousness and stopped breathing / having extreme difficulty breathing. Anyone know what could be the cause and how this can be prevented in the future?


Thanks, much appreciated

[Xplantdad]

In general...taken in a quote from the intrawebs...

Dialysis and Water Removal
Dialysis can only remove water that is in your blood. Only a small part of the water weight you gain is in your blood. If your feet are swollen (edema), fluid is in your tissues—not your blood.

During a treatment, pressure forces fluid out of your blood, into the dialysate, and down the drain. Some water from other compartments can then move into your bloodstream (this is called vascular refilling), so it can be removed. In the 3 or 4 hours of a treatment, only so much water is in your blood or has time to move there. The machine is set to a fluid goal— your “dry weight,” or weight without excess water. The dialysis machine keeps pushing, even if the water is not in your blood. And this is why you may feel awful. If your blood becomes too “dry,” your blood pressure drops. This happens if you go below your dry weight, or even if you are above your dry weight, but the extra fluid is not in your bloodstream.

Usually, closely monitoring your arterial and venous pressures (charting, too) will give an indication of when you are getting "dry"...and if necessary, you can have a bolus of saline at the ready from when the blood pressure starts to drop.

And yes, this has happened to my daughter (I am her caregiver) a few times...but never to the point of passing out. 

[justagirl2325]

Yes, it happens to my husband often.

When we first started and weren't super familiar with HD he would eat supper while connected and that would cause his BP to drop (he'd pass out, sometimes get sick).  So we know now just light snacks for him (fruit or toast).

The other reason, noted above, is trying to pull too much water.  Through trial and error we know he can't handle more than 3.0 in any four hour session - when he's been heavy in the past (i.e. 6 or 7 kilos over his dry weight) he'd try to push it and set it to 3.5 and he'd crash around 3.2.  So when he needs a lot taken off he has to do two days in a row.

His BP really has to be watched closely in the last hour every time.  The BP drops sometimes come with no warning.

[Fabkiwi06]

When I was on hemo, it happened a few times to me as well. I could usually feel it coming on before the big crash though. Never to the point of passing out. My cases were always because I was pulling too dry. We'd adjust my blood pressure medicines (would start taking my daily dose AFTER I left hemo) and a few times we'd cut the session short. Not as much of an issue now that I'm on PD.

[overtaker]

When I was on hemo, it happened a few times to me as well. I could usually feel it coming on before the big crash though. Never to the point of passing out. My cases were always because I was pulling too dry. We'd adjust my blood pressure medicines (would start taking my daily dose AFTER I left hemo) and a few times we'd cut the session short. Not as much of an issue now that I'm on PD.

could you describe what or how u feel before the crash? i will tell my mother to raise alarm once she felt it, it would be so much help

last time it happened the consequences was too dire, 4 strokes and collapsed lungs

[Fabkiwi06]

For me, it starts with a headache and turns in to feeling light headed. Then I would start feeling nauseous. Then it would crash and I'd get shaky with chills and REALLY sick to my stomach.

When my head started hurting, I'd mention it to my nurse and she'd turn the machine so I could see my blood pressure. I usually had coffee or water with me, so I'd sip on that. If it got to the lightheaded and nauseous bit, I'd flag down the nurse and they'd make their adjustments to stop.

Hope your mom is doing better after her last crash! That sound dreadful for both her and you!

[jmintuck]

I can tell when a Dialysis "crash" is getting ready to happen. I see funny fuzzy vision and just don't quite feel right, in a way. Kind of off kilter. I said one day, "Oh sh!t. I think I am getting ready to crash". I was just getting set up to crash any moment and they set me up with oxygen for a while. I felt so much better.

[kristina]

Fortunately (keep fingers crossed!!!) I only had one crash-experience, when I became too ambitious and tried to have too much water taken off all at once ... 
... Before this crash I became extremely tired and remained very tired through the rest of my dialysis-treatment and after my dialysis-treatment I could only very slowly get up again.
From then on I made absolutely sure to keep a very close eye on my dry-weight and fortunately (or because of it?) I could avoid another crash (touch wood!!!) ...
(...Keep fingers crossed I have the good luck to keep crash-free because I don't think my body could easily put up with another crash-experience ...)

[OlManRivah]

I keep a mirror with me while on the machine.  I monitor my BP using the mirror to see the machine.  It amazes me how many folks let a machine control their lives and not even monitor it.
As soon as I see my BP tank I alert the nurse.

[Charlie B53]

Wow!   I haven't had a crash, yet.  This is the reason I am so strict with my fluids.  Even those few times I have broken down and drank half a coffee cup of water I am telling myself I should be doing this!

I DO wear the support tube sock things, even though my calves are not swollen.  I think they make a huge difference in KEEPING the water from accumulating in my legs. Forcing it to stay more or less within the circulating system and more readily taken off during my treatments.

These support tubes are far more comfortable than any of the support socks or hose that I have ever had.  All those pure synthetics would not breath.  Besides the tightness they felt HOT and sweaty.  These cotton based tubes feel more like knee socks.  Good for me!

[Michael Murphy]

Recently as a result of a weakened heart following a heart attack my lungs began to hold fluid when I laid down.  To combat the breathing problems they began to pull 4 or 5 kilos off every  treatment. Since I was drinking 32 oz or less it was a amazing amount of fluid.  I started at about 142 kilos and 4 treatment later I was down to 133 kilos.  During this time my BP held reasonably steady, the fifth treatment my BP dropped like a stone.  That's the point my cardiologist stepped in and raised hell about the whole thing pointing out they could cause my weakened heart to give out. 

[Charlie B53]

Where does all that water come from?

I can understand sort of dehydrating the circulating system.  So are you telling me the flesh will give up water to refill the circulating system?  And the repeated 'draining' were slowly dehydrating the flesh but no symptoms appeared because the circulating system stayed within an allowable working range?

Wow, the body is a fantastically complex thing.