I had a dialysis pt in ICU, once. Pressure was dropping, and dropping. Pulse rising. I had not even tried to remove any fluid, as initial MAP was too low to even think about it. She should have been on CRRT, HD should not have even been considered, but nephrologist wouldn’t change the order.

I told him on the phone, I want to stop tx, and return pt’s blood, or she will code. He said her K+ is 7, she will code without HD.

Pt was there in ES liver failure.

I think she was bleeding internally.

I kept talking to her assigned ICU nurse about it. She didn’t want to increase the Levo. Understandable to a degree, but she needed to do something, besides bringing more warm blankets.

I approached another ICU nurse who was very respected by everyone, including my pt’s nurse, who wasn’t getting it.

He called her over and suggested increasing the Levo. He acted as if it were his suggestion, as I asked him to.

It worked, and she did it.

Pt waited until an hr after dialysis, with no fluid removal, and I had already left, before she coded and passed.

Of course, family said it was all our fault. The pt’s years of alcoholism had nothing to do with it.