Dialysis-associated hypotension: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*[[Nausea/vomiting]] | *[[Nausea/vomiting]] | ||
*Anxiety | *[[Anxiety]] | ||
*Dizziness | *[[Dizziness]] | ||
*Orthostatic hypotension | *Orthostatic [[hypotension]] | ||
*[[Syncope]] | *[[Syncope]] | ||
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**>20% plasma volume | **>20% plasma volume | ||
*Predialytic volume loss | *Predialytic volume loss | ||
**GI losses | **GI losses (e.g. [[vomiting]], [[diarrhea]]) | ||
**Decreased oral intake | **Decreased oral intake | ||
*Intradialytic volume loss | *Intradialytic volume loss | ||
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*Postdialytic volume loss | *Postdialytic volume loss | ||
**Vascular access blood loss | **Vascular access blood loss | ||
*Hemorrhage | *[[Hemorrhage]] | ||
*Medication effects | *Medication effects | ||
**Antihypertensives | **[[Antihypertensives]] | ||
** | **[[Opioids]] | ||
*Decreased vascular tone (sepsis) | *Decreased vascular tone ([[sepsis]]) | ||
*Cardiac dysfunction | *Cardiac dysfunction | ||
**LVH, ischemia, hypoxia, arrhythmia, pericardial tamponade | **[[LVH]], [[myocardial ischemia|ischemia]], [[hypoxia]], [[arrhythmia]], pericardial [[tamponade]] | ||
*Pericardial disease | *Pericardial disease | ||
**Effusion | **[[pericardial effusion|Effusion]] | ||
**[[Tamponade]] | **[[Tamponade]] | ||
*Hemolysis | *[[Hemolytic anemia|Hemolysis]] | ||
{{Dialysis complications DDX}} | {{Dialysis complications DDX}} | ||
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===Evaluation by [[Hypotension]]Timing=== | ===Evaluation by [[Hypotension]]Timing=== | ||
*Early in session: usually due to preexisting hypovolemia | *Early in session: usually due to preexisting [[hypovolemia]] | ||
*During the session: often due to blood loss (from tubing or filter leak) | *During the session: often due to blood loss (from tubing or filter leak) | ||
*Near the end: usually result of excessive ultrafiltration | *Near the end: usually result of excessive ultrafiltration | ||
Latest revision as of 16:23, 16 October 2019
Background
- Most frequent complication of hemodialysis (20%-30% of treatment)
Clinical Features
- Nausea/vomiting
- Anxiety
- Dizziness
- Orthostatic hypotension
- Syncope
Differential Diagnosis
- Excessive ultrafiltration
- > 0.35 ml/min/kg
- >20% plasma volume
- Predialytic volume loss
- Intradialytic volume loss
- Tube and hemodialyzer blood losses
- Postdialytic volume loss
- Vascular access blood loss
- Hemorrhage
- Medication effects
- Decreased vascular tone (sepsis)
- Cardiac dysfunction
- LVH, ischemia, hypoxia, arrhythmia, pericardial tamponade
- Pericardial disease
- Hemolysis
Dialysis Complications
- Dialysis-associated hypotension
- Dialysis disequilibrium syndrome
- Air embolism
- Missed dialysis (pulmonary edema)
Evaluation
Assess:
- Volume status (US)
- Cardiac function
- Pericardial disease
- Infection
- GI bleeding
Evaluation by HypotensionTiming
- Early in session: usually due to preexisting hypovolemia
- During the session: often due to blood loss (from tubing or filter leak)
- Near the end: usually result of excessive ultrafiltration
- Underestimation of patient's ideal blood volume (dry weight)
- Also consider pericardial or cardiac disease