Dialysis-associated hypotension: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Excessive ultrafiltration | *Excessive ultrafiltration | ||
**> 0.35 ml/min/kg | |||
**>20% plasma volume | |||
*Predialytic volume loss | *Predialytic volume loss | ||
**GI losses | **GI losses | ||
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*Postdialytic volume loss | *Postdialytic volume loss | ||
**Vascular access blood loss | **Vascular access blood loss | ||
*Hemorrhage | |||
*Medication effects | *Medication effects | ||
**Antihypertensives | **Antihypertensives | ||
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*Pericardial disease | *Pericardial disease | ||
**Effusion | **Effusion | ||
**Tamponade | **[[Tamponade]] | ||
*Hemolysis | |||
{{Dialysis complications DDX}} | {{Dialysis complications DDX}} | ||
Revision as of 00:09, 21 November 2016
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
- GI losses
- Decreased oral intake
- Intradialytic volume loss
- Tube and hemodialyzer blood losses
- Postdialytic volume loss
- Vascular access blood loss
- Hemorrhage
- Medication effects
- Antihypertensives
- Opiates
- Decreased vascular tone (sepsis)
- Cardiac dysfunction
- LVH, ischemia, hypoxia, arrhythmia, pericardial tamponade
- Pericardial disease
- Effusion
- Tamponade
- 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 Hypotension Timing
- 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