low heart rate during dialysis

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I am new to dialysis nursing and I had a question about this patient I had.

Typically it seems that patients will have higher heart rate during dialysis due to fluid being removed.

I have a patient whose heart rate goes down to 48, 46 during dialysis. Completely asymptomatic. Her baseline (pre and post) is in the 50s as she is on metoprolol 100 mg BID. It has been like this for about 3-4 months now consistently. Her blood pressure is great with no episodes of SBP

Is this typical for patients on beta blockers?

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Specializes in Dialysis (acute & chronic).

Did you notify the patients nephrologist about the low heart rate?

I have seen few patients who have clotted off their AV fistulas and AV grafts because of being on metoprolol and having bradycardia. They are not perfusing well and if they are not perfusing their access, what is going on with their brain and other organs?

The patient might not seem symptomatic but are experiencing side effects from the med and they are blaming it on dialysis...for example low or no energy, shortness of breath, fatigue, cold extremities, and swollen ankles, just to name a few.

I would call their doctor and make them aware of this.

This is not typical of dialysis patients on metoprolol.

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Specializes in Dialysis.

Autonomic dysfunction? Especially if she has a history of diabetes.

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I think with autonomic dysfunction is totally the opposite of the case we have here

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