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Dialysis patient on dialysis having vomiting and rbs 193 how to treat

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hemodialysis patient vomiting emergency evaluation hyperkalemia dialysis unit guidance

Vomiting in a dialysis patient needs urgent assessment today, especially if it began during or after dialysis. It can reflect low blood pressure/dehydration from dialysis, infection, missed/inadequate dialysis with high potassium or uremia, or rarely dialysis disequilibrium.
Do this now
  • If vomiting is ongoing, call the dialysis unit/nephrologist immediately or go to the emergency department.
  • Call emergency services now for confusion, severe headache, fainting, chest pain, shortness of breath, palpitations, severe weakness, seizure, fever, severe abdominal pain, blood in vomit, or inability to keep fluids/medicines down.
  • Check and record: blood pressure, pulse, temperature, oxygen saturation if available, timing of last dialysis, and whether a session was missed/shortened.
  • Do not give extra fluids freely, potassium-containing drinks, oral rehydration salts, or over-the-counter anti-vomiting medicines without the renal team’s advice. Fluid allowance must be individualized in dialysis patients.
  • Do not self-administer extra insulin or diabetes tablets just for an RBS of 193 mg/dL. This value is elevated but is not usually the immediate cause of vomiting; reduced kidney clearance can make insulin effects last longer and cause delayed hypoglycemia.
At the hospital/dialysis unit they may need an ECG and urgent blood tests, especially potassium, glucose, bicarbonate, urea, and infection assessment. Severe high potassium can be dangerous and dialysis patients should have the renal team informed promptly, since temporary medical measures do not remove the underlying issue (NHS hyperkalaemia guidance). Nausea/vomiting with headache, confusion, or seizures after dialysis can also be a warning pattern for dialysis disequilibrium (Tintinalli's Emergency Medicine, dialysis disequilibrium section).
Please seek urgent in-person care rather than trying to treat this at home.
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