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Table 2 Clinical pearls of hemodialysis-induced hemolysis for the emergency medicine physician

From: Hemolysis as a rare but potentially life-threatening complication of hemodialysis: a case report

1. Presentation: Hemodialysis–induced hemolysis can be very subtle
If a dialysis patient presents acutely during hemodialysis treatment with nausea, vomiting, and abdominal pain, be sure to have a high suspicion for this condition
2. Recognition: Emergency department physicians need to be aware of this hemodialysis complication in order to begin timely management
3. Differentials: Mechanical vs. Chemical
Think of the 3 C’s: Chlorine, Copper, and Chloramine
4. Intervention: In the hemodialysis unit:
tubing must be clamped immediately and not returned to the patient given the risk of hyperkalemia
In the emergency department:
Confirm hemolysis
Prepare for possible blood transfusion
Check serum potassium
Prepare for hyperkalemia treatment, including hemodialysis