How to manage missed dialysis in a person with CKD?

Question

Hello doctor,

My 67-year-old mother, who has chronic kidney disease stage 3, has been experiencing severe vomiting and diarrhea since yesterday morning. She has already missed one dialysis session because she is too weak to travel. Her blood pressure dropped to 90 by 60 last night, which is unusual for her. She is trying to drink water but throws up within minutes. What fluids should we try to give her between dialysis sessions? When should we consider emergency hospitalization? Her regular nephrologist is not available until next week.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

She should be taken to the hospital immediately if she has:

Persistent vomiting and inability to keep fluids down (which she already has).
Ongoing diarrhea leads to severe dehydration and electrolyte loss.
Decreased urine output or complete inability to urinate.
Swelling in legs, face, or abdomen (fluid overload).
Confusion, drowsiness, or agitation (possible uremic encephalopathy).

Signs of severe dehydration and low blood pressure:

Extreme weakness, dizziness, or fainting.
Cold, clammy skin.
Rapid heart rate.
Shortness of breath or difficulty breathing (possible pulmonary edema due to missed dialysis).
Since she cannot keep fluids down, hospitalization for intravenous fluids is the safest option.
Missing dialysis can cause dangerous fluid retention, leading to hypertension, pulmonary edema, or heart strain.
Vomiting and diarrhea already cause sodium and potassium imbalances, which can be life-threatening in chronic kidney disease (CKD) patients.
Uremic toxin buildup can cause nausea, confusion, and eventually coma.

I hope this helps.

Thank you.