I am not a dialysis nurse. I know a patient who gets severe leg cramps during dialysis. This has been happening more and more frequently. She is in her 90's and has been on dialysis for 10+ years. I have heard of people "not tolerating" HD...Is this what "not tolerating" looks like? Would PVD make it worse? Could this patient be hospice bound? I'm a peds nurse so I dont encounter this sort of stuff much, thanks for any insight you have
Dry weight is a pretty crude way to determine how much fluid to remove and a continuous hematocrit measurement during treatment would give a more accurate assessment of how much fluid removal this patient could tolerate. Remember most of the fluid in the body is not in the blood. As water is removed from the blood water from the tissues migrates back into the bloodstream. Unfortunately sodium and calcium is also carried out of the tissue and this can cause cramping. Nurseries is right that a longer treatment time or more frequent treatments would enable a gentler fluid removal. Also would be curious as to what her albumin level is. Low albumin is indicator of poor prognosis. Cramping is a very common problem and does not mean intolerance of dialysis as much as it means her therapy needs some fine tuning.
Last edit by Chisca on May 2, '13