muscle cramping/pain

  1. One of our patients experienced muscle (calf) bilateral pain, the day after dialysis, while walking. The pain increased to where she had to stop walking. DO patients have muscle pain, starting 19 hours post dialysis? She went to the ER and in ER the physician said that it was due to fluid shifting.
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  2. 9 Comments

  3. by   TaraGenX
    It also could have been too much fluid being taken off on treatment
  4. by   Mastersby2011
    After dialysis there is a fluid shift caused by less fluid in the vascular system than in the tissues. Fluid shifts usually happen sooner than 19 hours. If she had eaten high salt foods it would possibly change the times a little, frequently muscle cramping that late in the game occurs from changes more in the potassium level or in their calcium levels. Did you see any labs on this patient? If I were guessing I would bet on the electrolytes.
  5. by   Kenchiro
    We have a couple of patients that are extremly non compliant and bring in 7 - 8 kg of weight on a regular basis. They cramp every single treatment and there is nothing we can do about it. If we leave the fluid on them we risk CHF and other nasty things that go along with it.

    Now that being said the fluid shift will happen at different rates for different people, when someone has this much fluid on we see it happen on the machine where someone with only 3 kg on might not see it till sometime after treatment. Also, being diabetic will effect the rate fluid will shift.

    Our clinic uses a drug called Mannitol, this is a high powered diuretic. It helps the fluid shift that is happening from the tissue to the blood. We generally use this on patients that show signs of edema, periorbital and in the extremities. If a patient is having difficulty maintaining a BP and is 1 - 2 hours into treatment this will help out tremendously about 90% of the time.

    Now something to take into consideration is that Mannitol also works on the cerebral spinal fluid and actually is used to decrease intracranial pressure so there you go.
  6. by   NephroBSN
    Quote from Kenchiro
    We have a couple of patients that are extremly non compliant and bring in 7 - 8 kg of weight on a regular basis. They cramp every single treatment and there is nothing we can do about it. If we leave the fluid on them we risk CHF and other nasty things that go along with it.

    Now that being said the fluid shift will happen at different rates for different people, when someone has this much fluid on we see it happen on the machine where someone with only 3 kg on might not see it till sometime after treatment. Also, being diabetic will effect the rate fluid will shift.

    Our clinic uses a drug called Mannitol, this is a high powered diuretic. It helps the fluid shift that is happening from the tissue to the blood. We generally use this on patients that show signs of edema, periorbital and in the extremities. If a patient is having difficulty maintaining a BP and is 1 - 2 hours into treatment this will help out tremendously about 90% of the time.

    Now something to take into consideration is that Mannitol also works on the cerebral spinal fluid and actually is used to decrease intracranial pressure so there you go.

    Sodium modeling and UF profiling also help. I've found that neither Mannitol nor hypertonic do much.. Good old pushing works just as well or 200 cc NS.

    Also, muscle cramping that late can be the results of Mg inbalance.

    Most outpatient units don't use hypertonic anymore nor do they use Mannitol.. The only place I've ever used the latter was in RI( and I worked in 10 states in the last 4 years) .
  7. by   Juanay
    When I started in dialysis our units used only NS or Min UF, Decreased UF goal for Cramps. (Pushing on the foot, allowing the STABLE pt to stand as well)
    The facilities I am in currently DO use hypertonic, Bicarb, D50 as well as Na modeling and UF profiles. These pts also gain excessively b/t tx and the cycle continues.
    I have found here that with assessment (no edema, Lungs CTA (B) no SOB, statements of good appetitie, gaining weight, less active) many of these pt need increase DW. We as nurses are pt advocates and should (if protocols allow RN to increase DW)increase the DW and continue to monitor. DW's can change weekly.
    I have seen many pt's stabilize with an increase in DW and no more cramps, no symptomatic hypotension.
    JMHO
    Juanay
  8. by   NephroBSN
    Quote from Juanay
    When I started in dialysis our units used only NS or Min UF, Decreased UF goal for Cramps. (Pushing on the foot, allowing the STABLE pt to stand as well)
    The facilities I am in currently DO use hypertonic, Bicarb, D50 as well as Na modeling and UF profiles. These pts also gain excessively b/t tx and the cycle continues.
    I have found here that with assessment (no edema, Lungs CTA (B) no SOB, statements of good appetitie, gaining weight, less active) many of these pt need increase DW. We as nurses are pt advocates and should (if protocols allow RN to increase DW)increase the DW and continue to monitor. DW's can change weekly.
    I have seen many pt's stabilize with an increase in DW and no more cramps, no symptomatic hypotension.
    JMHO
    Juanay

    Ditto.. If a patient is consistently going home over the EDW then I will raise EDW. One place I worked we had standing orders for .5k per treatment either way.

    On the flip side of this coin. I had a fellow coming in with B/P's of 220/110 or higher and leaving with 170-180/100 and techs were only taking off 3-4k in a 4 1/2 hour treatment.. I started taking an extra .5k off every other treatment. Actually, I lowered his dry weight on his flow sheet and in the computer for the next flow sheet every other treatment. Got him down by about 4K in about 5-6 weeks with an incoming B/P of 160/90 and out going of 130/80 range. Patient couldn't believe how much better he felt.

    The nephrologist came in, patient told him his B/P was lower at end of treatment and Nephrologist promptly raised EDW by 4k.. I was wild.. I got out all of this patient's flow sheets for about 3 months and went over them with N. he agreed with my assessment and re adjusted the weight back down 4k.

    Hey, I didn't just fall off the turnip truck here..

    And guess what?? I told the patient not to bother to fill the Norvasc prescription the N had written for him..Can you imagine the N wanted to raise EDW and add Norvasc??????????

    OMG.
    Last edit by NephroBSN on Mar 5, '06
  9. by   Juanay
    Sometimes you gotta wonder about these N's and what they are thinking!!!
    HHHHMMMMMMM!
  10. by   NephroBSN
    Quote from Juanay
    Sometimes you gotta wonder about these N's and what they are thinking!!!
    HHHHMMMMMMM!
    Yeah I called one about UF profiling and he asked me if it was the same as Na Modeling.. I had to tell him,"If it were the same wouldn't we just call it Na Modeling?" I couldn't help it.. Then I explained what it does and he asked me which one I preferred. Now that's a first, a doc asking the nurse what to prescribe..LOL

    Are Crocks clogs?????????????
  11. by   Juanay
    Yeah, Lots of colors, some have holes ( not for use in clinic ) Around $30.00 here and @ home.
    I have actually had a N ask me what I think I should do in a situation and they reply "Sounds good to me, lets do it."
    The N's here are all very approachable. One of they great +'s here.
    Juanay

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