Originally Posted by knockandhello
Have a resident who has decided to cease haemodialysis.Am wondering how this will impact upon him.He still voids small amounts.What should I be looking for.?I imagine he will retain a lot of fluid.That he may become disorientated,.Will this be a slow process as he dies?Will he benefit from morphine or will metabolisation of morphine be hindered.
Fluid overload is not necessarily a problem. It strictly depends on how much fluid he takes in. Hyperkalemia will be the main cause of death. Many pt's who withdraw from dialysis pass quietly in their sleep. If the fluid intake is controlled it is actually a very gentle way of passing. Depending on his residual kidney function death usually occurs within 10-14 days. High potassium foods may hasten death and this is not the time to worry about diet restrictions. Pain usually is not an issuse. DO NOT withhold any pain meds. Most pt's I have dealt with complained of weakness, tireness, and loss of appetite. If your pt doen't have a problem with disorientation now, stopping dialysis won't necessarily cause one. On a personal note my uncle decided to withdraw from dialysis after several years and developing chronic leukemia in his 80's. He was at home at the time. After visiting with his newest great-grandchild he walked into the bedroom to take a nap and passed while sleeping. It happened to be exactly 10 days from his last treatment. Not a bad way to go at all.
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