Low Blood Pressure, Confusion, Loss of hearing, Cramping of hands

Well my father is going on 2 years with PD, recently was on HD for 12 years. Changed from HD to PD because of irregular heartbeats and was causing other heart problems. Just recently, about 3 months ago, he had part of his left leg amputated (specially from the shin down). Since then it has been a constant trip to the hospital these past couple of months. After his PD treatment, he has been in this state of confusion, low blood pressure, loss of hearing, cramping of hands and just basically incoherent. And its been a repeated process, we (as in my sister and I) find him in this state, call 911, they hook him to an iv and transfer him to the nearest hospital, they take multiple blood samples (Cultures come back with no signs of infections), xrays and ct scans show nothing irregular. They release him a couple days later and it just repeats itself all over again. It has been very frustrating with no answers, and after doing some research, it may seem he is either severely dehydrated and pulling out to much fluid or there is a lack of protein in his diet. A little background on his test results: Prothrombin Time (PT INR) - 2.8, Albumin 3.3 g/dl, glucose 144 g/dl. I am not to familiar with his solution intake for PD, but i know they are colored coded, and he is doing 2 yellow bag solutions and 1 green bag. He does use the cycler more frequent than manually. Any ideas on what it might be?

It sounds to me as if he is managing to dehydrate himself with PD. That would lead to low blood pressure, loss of hearing, cramps, and incoherence. Perhaps he does not need that green bag and should do another yellow? This is something his PD nurse should be able to help sort out.

His albumin is VERY low–and this may be part of the reason why he is losing body water so easily. For people on dialysis, the goal is 4.0 g/dL, and anything under 3.5 g/dL is a risk factor for hospitalization and poor outcomes. His blood sugar is higher than normal, and another yellow bag instead of the green could help with that. Does he have diabetes?

Yes he is diabetic, unfortunately last night he entered that state of incoherence and my sister helped him drain manually. Well, that made it worse. He became totally unresponsive and had to be taken to the emergency room. I will headed to the hospital, hopefully we can get answers this time.

I pray you get the information you need, but it sounds like he’s suffering from dehydration. Where is your PD nurse and nephrologist?

Thank you, I have been in contact with his pd nurse and I have scheduled a meeting with his nephrologist, cardiologist, podiatrist and primary doctor. Seems that there is a lack of communication between the pd department and his primary doctor. As for update on my father, I just got back from the hospital and his vital signs are back to normal and doing great.

Did his nephrologist and other doctors figure out what was causing his symptoms? How is he doing now?

Hello Beth, so it seems that he was malnourished and dehydrated. With the combination of both seemed to be the problem according to his primary doctor. (His primary nephrologist is on vacation, so we havent met with him) but my father seems to be doing well! We have him on a balance diet and he is taking glucerna shakes which seem to give him the proper protein he was missing, he started a new medication to help with his low blood pressure and he is not pulling out so much fluid through pd. With a solid plan moving forward looks like he is going to be fine.

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I’m really glad to hear that. Thanks for updating us.

Peritoneal dialysis (PD) and hemodialysis (HD) are dialysis alternatives for end-arrange renal sickness patients in whom preemptive kidney transplantation isn’t conceivable. The determination of PD or HD will normally be founded on understanding inspiration, want, geographic separation from a HD unit, doctor as well as medical attendant predisposition, and patient instruction. Shockingly, numerous patients are not taught on PD before starting dialysis. Most examinations demonstrate that the relative danger of death in patients on in-focus HD versus PD changes after some time with a lower chance on PD, particularly in the initial 3 months of dialysis.