HEMODIALYSIS COMPLICATIONS

Treat same
except for
INTRADIALYTIC MUSCLE CRAMPS CATHETER-RELATED 6 weeks AVF/AVG INFXN
HYPOTENSION BACTEREMIA
(collect 2 blood cultures: 1 from
periphery & 1 from CVC) LOCAL: drain abscess +
Abrupt drop in BP: topical and/or abx
> 40 mmHg SBP TREATMENT until clear (2-3 wks)
> 20 mmHg DBP
 Hypertonic fluids (NS or D5W)
 Use muscle cramps board VANCOMYCIN 25 mg/kg IV post HD x 1 dose
or BP <100/<40
 Accurate goal weight
 Adjust dialysis Rx ADD
 Replace electrolytes if low GENTAMICIN 2 mg/kg IV post HD x 1 dose
 Quinine 300 mg po qHD (if hemodynamically unstable or suspect gram -ve)
ACUTE TREATMENT or daily PRN
 Decrease ultra-  Vitamin E 400 units po daily
filtration rate USE
 Trendelenberg position CEFTAZIDIME 2 g IV post HD x 1 dose
 Normal saline bolus up (if intolerant to gentamicin)
to max total volume 1L

LONG-TERM TXT Remember treat AVG/AVF

STAPH AUREUS for 6 weeks
GRAM -VE
 Accurate goal weight
 Adjust dialysis Rx
MSSA
 Fluid & salt restrictions CEFAZOLIN 2g IV post HD x 4 wks
 Avoid eating directly CEFTAZIDIME 2g IV post HD x 3 wks
before or during dialysis (if catheter removed then x 2 wks)
 Avoid anti-HTN before VANCOMYCIN 500 mg IV post HD
dialysis MRSA
or 20 mg/kg post every 2nd HD ADD
 Midodrine 2.5 – 10mg
po before, at start or CIPROFLOXACIN 500 mg po
mid run x 4 weeks or 400 mg IV daily
(if Pseudomonas)