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[This message has been edited by Gary Peterson (edited 03-10-2000).]

What do you do at your clinics when patients come in for hemodialysis with no extra weight on them. We have a pt that has been coming in three days a week for dialysis for the last few years. He is about 78 years old, 5'8", 165 lbs and for the last few weeks has been coming in with no extra weight on him at all! He is very disciplined with his diet. He eats and drinks exactly what his doctor says(not too much or too little fluid). He says he hasn't been doing anything different the last few weeks. He looks Great! I just don't understand it. The doctor has us lower his average weight so that it looks like he has gained fluid. I'm afraid we are going to completely dehydrate him if he keeps coming in three days a week like this. What do you think??

When looking at this situation several factors come into play. You not only need to look at the dry weight (because this often fluctuates). you need to look at the B/P assess for swelling and lung sounds. Sometimes patients lose body weight which can look like they are coming in under DW or at DW when they have actually lost body mass.

When this occurs we usually challenge the dry weight and take an extra 0.5kilo every tx until we establish a new DW.