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Fluid overload in renal disease is similar to congestive heart failure. Given the prevalence of comorbidities such as hypertension and cardiac disease in this population, dyspnea and pulmonary edema may result from either pump failure from a primary cardiac etiology, or excretion failure from the poor renal function. Additionally, the ESRD patient may enter a state of high‐output heart failure due to the presence of an AV fistula. The inability to clear waste products can also result in uremic cardiomyopathy [4].

Diagnosis and treatment of fluid overload in this patient population overlap with the heart failure cohort. In the acutely ill patient, management is similar, including oxygen and nitrates. High‐flow nasal or face mask oxygen, noninvasive positive‐pressure ventilation, or intubation and ventilation may be required for worsening respiratory distress. Focused point of care ultrasound can provide information regarding the nature of cardiac contractility or pericardial effusion from uremia. Ultimately, dialysis may be required to offload fluid and facilitate return to baseline hemodynamic and pulmonary function [4, 11]. The availability of emergent dialysis must be considered by the EMS clinician when deciding on the most appropriate destination for the patient.