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)

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