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Hypotension is common during dialysis, occurring in 10%‐50% of patients. Often, this is a direct result of fluid shifts from the dialysis procedure. At times, there may be calibration issues and the patient has an overzealous removal of fluid, leaving him or her intravascularly depleted. Additionally, the medications and temperature shifts commonly found in the dialysis circuit, combined with the patient’s baseline autonomic irritability, frequently contribute to decreased blood pressures [4]. However, care must be given not to attribute all postdialysis hypotension to hypovolemia, as these patients are at higher risk for septic shock, cardiac tamponade, bleeding, myocardial ischemia, and heart failure.

Treatment of hypotension is directed at the cause. Should dialysis‐related hypovolemia be the likely insult, small boluses (250–500 mL) of isotonic crystalloid IV fluid should be considered, followed by reassessment of the patient for response and any respiratory distress [4]. During any care transitions, EMS clinicians should clearly communicate the volume of any administered IV fluids.