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

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