Prevention and maangment of hypotension by aniqa atta

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

1. MANAGEMENT AND PREVENTION OF HYPOTENSION ANIQA ATTA BS: RENAL DIALYSIS TECHNOLOGY MPHIL: MOLECULAR BIOLOGY AND GENETICS

2. Symptoms of Hypotension Muscle cramps Chest pain Nausea Dyspnea Light-headedness Paleness

3. Symptoms of Hypotension Abdominal pain Vomiting Weakness Vertigo Sweating

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. Drug Treatment If all else fail, the following drug treatment is used: Levocarnitine Midodrine sertraline

10. 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

11. Drug Treatment Sertraline: 5 to 10mg/day

12. 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

13. Prevention of Hypotension Consider use of blood volume monitor Consider a trial of Midodrine or sertraline Higher potassium dialysis solution