I actually had a Dialysis cardiac arrest yesterday. Upon arrival the patient was on dialysis machine was getting a defib shock from the AED, no ROSC. Fortunately the dialysis nurse was a former career Paramedic (18 years). I was able to use the shunt for IV access and immediately administered Epi and applied my monitor to be able to view. Difficult to determine with a possible V-tach type complex, bizarre wide QRS. I asked for the pre-dialysis base line labs. The critical values were K+ was 9.15, Na+ was 120. I administered 4mg of Mg+ and 25 meq of NaHCo3 (for sodium and volume replacement). Spontaneous pulse occurred in about 3 minutes. This is not unusual due to the cardiac arrest etiology is not caused by coronary occlusions rather by electrical/nervous system disruptions.
In fact, my success rate is much greater on immediate post dialysis patients than on true coronary patients.
I found a link with the "normal" lab readings of dialysis patients. I changed the wording a little: I keep a copy in my field guide to refer to for ill dialysis patients. Usually such centers have a recent copy of current labs. True, the treatment may not change, but being able to focus on the problems helps makes a better diagnosis.
Those with dialysis : (NOT NORMAL LAB VALUES!!!)
Albumin
Albumin is a protein that transports many small molecules in the blood. Albumin also keeps blood from leaking into the surrounding tissues.
For adults, an albumin level of 3.5 to 5.0 grams per deciliter (g/dL) is desirable — whether you're on dialysis or not. Lower levels may suggest that you're not eating enough protein.
Blood Urea Nitrogen, BUN
Urea and nitrogen are waste products created when protein is broken down in your body. Dialysis helps rid of these body wastes. The amount left in the blood indicates how well the dialysis is working.
For adults on dialysis, a blood urea nitrogen level less than 65 milligrams per deciliter (mg/dL) is desirable just before a dialysis session. The doctor (Nephrologist) will monitor the rate of reduction of the blood urea nitrogen level during dialysis to help determine how much dialysis they need.
Calcium, Ca+Calcium supports bone growth and normal heart and muscle function. If your calcium level is too low, your bone density will suffer.
For adults on dialysis, a calcium level of 8.5 to 10.0 mg/dL is desirable. Lower levels may suggest that you're eating too many phosphorous-rich foods, such as dairy products, whole grains and nuts. Higher levels may suggest that you're getting too much supplemental calcium or vitamin D or developing a bone disease known as renal osteodystrophy, a common problem in people with kidney disease and those receiving dialysis.
Creatnine, Creat
Creatnine is a waste product produced by your muscles and, to some extent, from the meat in your diet. The amount of creatinine in your blood indicates how well your kidneys are functioning.
If the patient is on dialysis, the most desirable creatinine level can vary depending on how muscular they are, the type of dialysis they chose and how much kidney function they have left. High creatinine levels may suggest that dialysis is inadequate or that their not consuming enough calories.
Ferritin
Ferritin is a protein that stores iron in the body. The amount of ferritin in your blood is directly proportional to the amount of iron available in your body to produce hemoglobin — the protein that carries oxygen in the blood.
For adults on dialysis, a ferritin level of 200 to 500 micrograms per liter (mcg/L) is desirable. Higher levels may indicate inflammation or simply follow repeated blood transfusions. Lower levels may suggest that they are not absorbing enough iron from their iron supplements.
Folate
Folate helps produce and maintain new cells.
For adults on dialysis, a folate level higher than 20 mcg/L is desirable. Lower levels may suggest that you're not taking your dietary supplements.
Glycated hemoglobin (HbA1c)
If you have diabetes, your doctor may do a glycated hemoglobin test to determine how well you're managing your blood sugar. The test reflects your average blood sugar level for the two- to three-month period before the test.
For adults, a glycated hemoglobin level of 7 percent or less is desirable — whether you're on dialysis or not. Higher percentages indicate poor blood sugar control.
Hematocrit, HCT
Your hematocrit is the percentage of red blood cells in your blood.
For adults on dialysis, a hematocrit of 33 percent to 36 percent is desirable. Lower percentages may suggest that you've lost some blood, your iron level is too low or your dosage of erythropoietin — a hormone normally produced by the kidneys — needs to be adjusted.
Hemoglobin, Hgb
Hemoglobin is the protein that carries oxygen in the blood.
For adults on dialysis, a hemoglobin level of 11 to 12 g/dL is desirable. Lower levels may suggest that you've lost some blood, your iron level is too low or your dosage of epoetin alfa (Epogen, Procrit) or darbepoetin (Aranesp) needs to be adjusted.
Iron
Iron works with protein to make the hemoglobin in red blood cells. Iron is stored in the liver, spleen and bone marrow.
For men, an iron level of 50 to 150 mcg/L is desirable — whether you're on dialysis or not. For women, the desirable range is 35 to 145 mcg/L. Higher levels may follow repeated blood transfusions. Lower levels may suggest that you're not absorbing enough iron from your iron supplements.
Your doctor may also measure the percent saturation of iron in the blood, which indicates how much usable iron you have in your blood. A value higher than 20 percent will improve your body's response to epoetin alfa (Epogen, Procrit), a hormone that stimulates the bone marrow to produce red blood cells. Higher percentages may follow repeated blood transfusions. Lower percentages may suggest that you're not absorbing enough iron from your iron supplements.
Parathyroid hormone
Parathyroid hormone balances your calcium and phosphorus levels.
For adults on dialysis, a parathyroid level of 5 to 15 picomoles per liter (pmol/L) is desirable. Higher levels may suggest poor calcium and phosphorus control or overactive parathyroid glands.
Phosphorus
Phosphorus plays an important role in bone health. The mineral also helps maintain a normal acid-base balance (pH) in your body. High levels of phosphorus can deplete your blood of calcium. Low levels of phosphorus can lead to muscle weakness.
For adults on dialysis, a phosphorus level of 3.0 to 5.5 mg/dL is desirable. Higher levels may suggest that they have eaten too many phosphorous-rich foods or that you've taken too little phosphate-binding medication or haven't taken it with your meals. Lower levels may suggest that they have taken too much phosphate-binding medication or aren't consuming enough protein or calories.
Potassium, K+
Your body needs potassium for normal heart and muscle function. Potassium levels too high or too low can slow or stop your heart.
For adults on dialysis, a potassium level of 3.5 to 5.5 milliequivalents per liter (mEq/L) is desirable. Vomiting and diarrhea can cause lower potassium levels. Higher levels may suggest that their eating too many potassium-rich foods or too much food in general.
Sodium, Na+
Your body needs sodium to function properly. Low levels of sodium can cause muscle cramping, confusion and seizures. High levels of sodium can cause excessive thirst. Extremely high levels can lead to confusion and seizures. As well as extreme low sodium.
For adults, a sodium level of 135 to 145 mEq/L is desirable — whether you're on dialysis or not. Lower levels of sodium may indicate that they are retaining too much fluid.
Vitamin B-12
Vitamin B-12 helps form red blood cells and maintain a healthy nervous system.
For adults on dialysis, a vitamin B-12 level of 200 to 650 nanograms per liter (ng/L) is desirable. Lower levels may suggest that they are not absorbing enough vitamin B-12 from their dietary supplements.
Other tests
PT: How long it takes the blood to clot (prothrombin time). If the result is high, the blood is too thin and their at greater risk of bleeding. If it's low, the blood is too thick and may clot in the dialysis machine or within the venous access point.
Your doctor may also test for blood for signs of exposure to hepatitis B or hepatitis C, serious infections that can spread through contact with contaminated blood.
Cholesterol and triglyceride tests are common as well. Higher levels of low-density lipoprotein (LDL), or "bad," cholesterol and lower levels of high-density lipoprotein (HDL), or "good," cholesterol increase the risk of heart disease, as can high levels of triglycerides
Hope this helps!
R/r 911
