[sueinga]

Can anyone tell me their reasoning when deciding to use either
a bolus of normal saline vs
hypertonic saline vs
mannitol vs
dextrose
to treat dialysis induced hypotension
thanks

[traumaRUs]

Well at my dialysis units - its easy - we only have NS! Seriously though - dialysis induced hypotension is a volume issue so NS makes total sense. Why give mannitol? That is only going to affect the osmotic gradient. Dextrose isn't appropriate either as it isn't a voume expander.

Do you use something other than NS?

[km5v6r]

The acute units I worked in Mannitol and Dextrose were not options. Hypertonic saline and 25% Albumen would be used if the pt had fluid on that needed to be shifted to the intravascular space. The pt's that had 3-4+ pitting edema to the hips and developed hypotension after 30-45 mins on dialysis. If the pt was at or below dry wt, had no signs of excess fluid (clear lung sounds, no edema etc) and became hypotensive then we would give a saline bolus. We also never gave hypertonic saline or albumen in the last 60 mins of the treatment. Two of the cardinal sins in acute dialysis were to take someone off early and to leave fluid on. Both situations put the call nurse at risk of coming back in to finish the job.

[sueinga]

I have seen them use all 3 in my facility. The other day I used Sodium CL 23% 10ml and it raised the BP in a minutes time...but half hour later it was low again. The on another pt I used a 250cc bolus of NS and he still did feel better or increase BP- I had to rinse him back at his insistance and then he felt better but he missed almost half his tx time.

I've read that Mannitol is usually given for first dialysis tx to prevent symptoms and DDS. Since I'm still learning I am not sure what to use but guess at this stage that a bolus of NS would be first choice

[diabo]

We sometimes give a half amp of Mannitol spaced an hour apart but not the last hour. Albumin if the lab value is low. There is always a gradient shift in full HD mode that can be another ingrediant for hypotension. That's why running in bypass works for extra fluid removal. Slowing the BFR and the DFR also helps slow the shift. Lowering the dialysate temp a degree also helps sometimes. The machine temp should match the patient's temp and not automatically be set to one standard. Be careful with the hypertonic sodium and for that matter raising the sodium at all. It can put an extra load on the already overworked and weak heart. Even if it's protocol, it doesn't hurt to run it by the doctor. Some doctors don't like you messing with the sodium at all .
Steve