Fluid overload with low Bp

How low of BP?

SBP 106 DBP 50 ,patient is not on any anti hypertensive

That is her starting HD BP , during dialysis BP fluctuating between 140 / 60 to 110/ 50

I encounter that every day. The extra fluid is not always in the vascular space, which may account for the low B/P.

Thank you for your reply ,

I heard mild creeps on auscultation on her lower lung ,but how can I remove the extra fluid with low BP

Sorry , creps

Only every other treatment. Other than that it's not a problem.

Tells the creeps to lower their voices so you can hear better.

Midodrine and dialysis as tolerated is what I see.

Think of LVF any time you have extra volume with low B/p. Many times as you remove volume B/p increases. This is true for all pts not just dialysis pts. Also we can do sequencial dialysis and remove Fluid without removing electrolytes. When you move fluid from the tissues, and lungs the B/p should recover

👍👍thanks!!

Albumin and midodrine help most of the time, some just don't want to give it up tho