Scenario; 62-year-old male with End Stage Renal Disease (ESRD) is admitted in ICU for community-acquired pneumonia. The patient is responding to antibiotics. Patient in ICU previously had two episodes of hypotension while in hemodialysis (HD) session, requiring stoppage of HD and infusion of a fluid bolus. Today Nephrology service wrote orders to hold food before and while the patient is in HD session?
Explanation: Studies have shown that peripheral vascular resistance (PVR) drops 20 to 120 minutes after the ingestion of food, and this effect may be pronounced in chronic ESRD patients, on HD due to autonomic dysfunction. This is one easy trick which can be useful in ICU :)
References:
1. Barakat MM, Nawab ZM, Yu AW, et al. Hemodynamic effects of intradialytic food ingestion and the effects of caffeine. J Am Soc Nephrol 1993; 3:1813.
2. Sherman RA, Torres F, Cody RP. Postprandial blood pressure changes during hemodialysis. Am J Kidney Dis 1988; 12:37.
3. Kearney MT, Cowley AJ, Stubbs TA, et al. Depressor action of insulin on skeletal muscle vasculature: a novel mechanism for postprandial hypotension in the elderly. J Am Coll Cardiol 1998; 31:209.
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