Wednesday, 5 March 2014

The Risks of Haemodialysis Dose, Shit Happens

Wednesday 2014-03-05

A mouse is having an elephant dose.

To avoid eviction I had to increase my hours from 3 and eventually to 5 before I see the doctor on 17 March. As I am less than 50 kilograms, right now I feel like a poor mouse whose getting the elephant dose. I’ve been doing 3 hours since 12 Oct 2013, which have been working well and gradually making me better.

The moment an adult patient sits on the dialysis chair, his journal on the conveyor belt begins, most of whom would be prescribed a dose of 5 hours, 3 days weekly, 35.5 C machine temperature, Sodium 140mmol/L, heparin (bolus 1000 unit, hourly rate 1000), and etc..., indifference of age, gender and weight. Patients who are out of this rage would be disadvantaged, and I think these poor souls would be likely to fall into haemodialysis mortality group.

I remember seeing some incidents while sitting on the dialysis chair. The other day, some poor guy nearly pasted out. What happened was the fast speed of removing his fluid brought his blood pressure down too quick and too low, his heart beat reduced to a worrying level. To prevent an ambulance situation, all his vital figures must be up, to achieve this, fluid must be restored, and saline was therefore reinfused into his blood.

That day the nurses were very worried and busy, checking his blood pressure in short intervals, adjusting his chair up and down, down and up, and he was attended with extra kindness. After about half an hour, his condition was stabilised, he was letting to sleep and continue his session and the nurses wiped off their sweat. This patient’s UF target that day was totally stuffed, but I saw he got two extra packs of cookies (2 cookies in 1 pack) taking home.

There was another woman whose luck was poorer, experienced a similar episode but which was in the beginning of her session. Her condition wasn’t stable enough to continue, so the session was aborted within half an hour she started. She came in 44kg and went home more than half a kilogram heavier and I noticed the UF target on her machine was 3 litres and it was a Saturday! The poor woman ended up the day not only didn’t have her fluid off instead more fluid was on, not to mention her toxins. The nursed had their hands on their mouths when recording her weight and eyeing each other with strange looks.

Last week my fellow patient, 2 hours into her 5 hour session she wanted to go to the loo, she was washed back and temporarily taken off the machine. When she stood up her legs started cramp which was another side effect of removing fluid too fast. She was gasping, her face contorted, and yet too polite to curse, but one may discern some smothered sound, she kept on saying sorry while obviously she was miserable suffering tremendous pain and that went on for about half an hour. In the end, the nurses decided to send her home. What a pity, they used the BVM machine on me for lie detecting purpose (detail in my other blog) instead of on her which may have saved her from this incident. By the way, the reason for her loo break, I think was not to pee, after what had happen to her earlier whatever she was holding was not there anymore, women normally can’t hold a pee this long, only shit can be easily scared off.

If only some people could respect science rather than setting their imaginary goals on dialysis machine, patients would not have to suffer anymore than what their illness had brought to them.
There are some unbelievable stories that dialysis concentration solutions could run out of stock which had happened to me twice, once for real and the other I keep my reservations.

When bad things happen, what can you do?


Like our current Prime Minister used to say, ”Shit happens”!

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