title: Management and prevention of hypotension during dialysis
this presentation will cover all aspects of hypotension management occurs during dialysis. Its sign and symptoms and treatment strategies
4. Management of Hypotension
• Place the patient Trendelenburg position(if respiratory status
allows)
• A bolus of 0.9% saline(100 ml or more if necessary) should be
rapidly administered through the blood line
• The ultrafiltration rate should be reduced to as near zero the
patient should then be observed carefully
• Ultrafiltration can be resumed carefully(at a slower rate) once
vital signs are stabilized
• As an alternative to saline mannitol, albumin and glucose solution
can be used to treat hypotensive episodes
5. Management of Hypotension
• Hypertonic saline may respond better to rapid administration
rather than slower administration of 5 mins of an equivalent
sodium load administration
• High solution sodium is advised
• Nasal oxygen administration
6. Management of Hypotension
• Hypertonic saline may increase thirst, prevent achievement of dry
weight, worsen fluid overload
• In most cases hypotension is due to excess ultrafiltration
• Other explanation should be sought if BP does not respond to
reasonable saline replenishment especially cardiac causes, GI
bleeding and sepsis
7. Management of Hypotension
• If hypotension occurs repeatedly then review:?
• Dry weight(too low)
• UF rate
• Weight gain between session(carefully counsel patient especially
about salt restriction, limit weight gain up to 1kg/day, look for
hidden food such as soups and salt intake)
• Dialysate sodium(keep above plasma sodium)
• Use bicarbonate not acetate dialysate
8. Management of Hpotension
• Lower dialysate temperature up to 36 degree centigrade but some
patients are uncomfortable
• Increase Hb
• Avoid food intake(but for some patients it can be the encouraged
time for eating food)
9.
10. Drug Treatment
If all else fail, the following drug treatment is used:
• Levocarnitine
• Midodrine
• sertraline
11. Drug Treatment
Levocarnitine :
• 20mg/kg/treatment IV
• At the end of dialysis to improve hypotension
Midodrine:
• An oral alpha agonist
• 2.5 to 10mg min before dialysis
• Increase peripheral vascular resistance
13. Prevention of Hypotension
• Use a dialysis solution of 35.5 degree centigrade, set dialysis
temperature at least below 0.5 degree centigrade below
• Review dietary sodium intake and other fluid intake, fluid intake should
ideally be less than 1L per day in anuric patients
• Extend weekly dialysis time
• Consider the patient dry weight
• Assess the benefit of predialysis hemoglobin level consistently= 10-
11g/dl
• Do not give food orally or glucose orally during dialysis or immediately
preceding, dialysis to hypotensive prone patients
14. Prevention of Hypotension
• Consider use of blood volume monitor
• Consider a trial of Midodrine or sertraline
• Higher potassium dialysis solution
