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Prevention and maangment of hypotension by aniqa atta
- 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)
- 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
- 12. Drug Treatment Sertraline: • 5 to 10mg/day
- 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