Concluded Case

Hypotension in CKD

65 years old female with ESRD secondary to PCKD, now having symptomatic hypotension (80/40), since last 6 months. Past medical history negative for HTN or DM or CAD. Current meds: Pantoprazole. Labs: ECG, 2D Echo, Cortisol, TSH, CBP and CUE normal. What's the diagnosis and further investigation ?

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Symptomatic hypotension since last six months?? 1. Most of the cases of PCKD are known hypertensive. Your case is negative for hypertension. Strange. 2. What i have understand from the case u presented is patient is having sympyomatic hypotension 80/40 since last 6 months. If it is the case, the base line BP of patient may not be too high. In the patient on Maintenance hemodialysis, one of the thing which a clinician shud be concerned of is volume status. We should always keep a patient in euvolemic status so that neighter the patient have breathing problm due to volume overload nor the patient feel weak drowsy due to volume depletion. In this case as u said its symptomatic hypotension for long, patients dry weight has not been set correctly. Increase his dry weight a bit a look for change. By increasing dry weight, i mean that if the patient comes with 65 kg pre dialysis weight and you keep him at 62 kg post dialysis weight everytime then may be there a possibility that 62 kg may not be his dry weight and its less than that. Try to keep it 62.5 kg on next time and then look for change.

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Symptomatic hypotension since last six months?? 1. Most of the cases of PCKD are known hypertensive. Your case is negative for hypertension. Strange. 2. What i have understand from the case u presented is patient is having sympyomatic hypotension 80/40 since last 6 months. If it is the case, the base line BP of patient may not be too high. In the patient on Maintenance hemodialysis, one of the thing which a clinician shud be concerned of is volume status. We should always keep a patient in euvolemic status so that neighter the patient have breathing problm due to volume overload nor the patient feel weak drowsy due to volume depletion. In this case as u said its symptomatic hypotension for long, patients dry weight has not been set correctly. Increase his dry weight a bit a look for change. By increasing dry weight, i mean that if the patient comes with 65 kg pre dialysis weight and you keep him at 62 kg post dialysis weight everytime then may be there a possibility that 62 kg may not be his dry weight and its less than that. Try to keep it 62.5 kg on next time and then look for change.

Thank you for valuable advice.
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Acute on chronic ckd ; immediate dialysis n further management as per lab reports; also personal management irrespective of lab reports as lab reports r just guide lines; they see the sample n not the patient

It mau be due to haemodialysis. Hypotension is the most common complication

Patient is having continued hypotension, pre & post HD.
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Excellent explanation@Dr. Saurabh Pathak sir...

Great explaination saurabh sir

Thanks prachi.
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Patient is having continued hypotension, pre & post HD. She has ESRD which means CKD - 5, on HD, for last 9 years.

Or some cardiac etiology
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@rule out gram negative cyst infection

Cyst infection presents with pain, fever, burning and hypotension can occur when infection is severe enough to cause hypotension/shock.
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