Differential Diagnosis for Hypotension in ESRD Patients
Single Most Likely Diagnosis
- Hypovolemia: This is the most common cause of hypotension in ESRD patients, often due to excessive fluid removal during dialysis or inadequate fluid intake between sessions.
Other Likely Diagnoses
- Dialysis-induced hypotension: A common complication of hemodialysis, caused by rapid fluid removal, leading to a decrease in blood volume and subsequent hypotension.
- Anemia: Severe anemia can lead to decreased oxygen delivery to tissues, resulting in hypotension.
- Cardiac dysfunction: ESRD patients are at increased risk of cardiac disease, which can cause hypotension due to decreased cardiac output.
- Medication side effects: Certain medications, such as antihypertensives, can cause hypotension in ESRD patients.
Do Not Miss Diagnoses
- Sepsis: Infection is a common cause of hypotension in ESRD patients, and sepsis can be life-threatening if not promptly recognized and treated.
- Bleeding: Internal bleeding, such as gastrointestinal bleeding, can cause hypotension and is a medical emergency.
- Cardiac tamponade: Although rare, cardiac tamponade can occur in ESRD patients, especially those with underlying cardiac disease, and can cause life-threatening hypotension.
- Pulmonary embolism: ESRD patients are at increased risk of thromboembolic events, including pulmonary embolism, which can cause hypotension and is a medical emergency.
Rare Diagnoses
- Adrenal insufficiency: Although rare, adrenal insufficiency can occur in ESRD patients, especially those with underlying autoimmune disorders, and can cause hypotension.
- Pheochromocytoma: A rare tumor that can cause hypotension due to excessive catecholamine release.
- Autonomic dysfunction: Some ESRD patients may have underlying autonomic dysfunction, which can cause hypotension due to impaired sympathetic nervous system function.