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Discussion

Hypotension

So I work in chronics and I have a patient that came in with a sbp in the 80s asymptomatic. She had just been given a prescription for midodrine. I started her treatment and throughout the entire treatment her sbp was stable 110-120. It only dropped back down to the 80s after her treatment was completed and her blood returned. After a few minutes it came back up to 100. My question is why does the bp improve during dialysis?

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    Do you know when the midodrine was taken by the patient? Peak effect of midodrine is one hour and the half life is 3 hours. You could just be seeing the effects of this medication. Other factors would be dialysate sodium, if the dialysate sodium is higher than the patients serum sodium this is pulling water into the circulation during the treatment.

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    • Experts

    It could be because the patients heart failure is such that with the dialysis machine taking the work load off of the heart the B/P will increase because the "work load is less"...and it depends on when the med was taken.

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    What Esme said.

    There are many variables unique to each patient, including cadiovasculature medications, and their timing/ dosage.

    Sometimes, fluid removal (to a point) reduces cardiac workload, and BP improves. Hint: think systemically... right heart vs left heart, PVR, and issues such as diabetic vasculopathy common to many ESRD patients.

    Also, some patients with cardiac (mechanical) issues do better just slightly fluid overloaded (gives the heart "something to work against" systemically).

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