Fifteen minutes before the end of a hemodialysis treatment, a patient complains of dizziness and nausea. These symptoms are most likely due to:

• A. Hypotension
• B. Hypoglycemia
• C. Infection
• D. Anxiety

Answer: (A)

Dizziness and nausea during a hemodialysis session, especially as treatment is winding down, point to a drop in blood pressure from fluid removal. As ultrafiltration reduces the circulating blood volume, blood pressure can fall and cerebral perfusion decreases, leading to lightheadedness, dizziness, and nausea. This scenario is a classic sign of intradialytic hypotension.

Other possibilities don’t fit the timing and symptom pattern as well. Hypoglycemia can cause dizziness but is not a common, direct consequence of dialysis alone and would usually come with symptoms like sweating, trembling, or confusion if low glucose were the cause. Infection typically presents with fever or systemic signs and isn’t specifically tied to being near the end of a dialysis session. Anxiety can cause dizziness, but it’s less likely to present as a direct, session-timed physiologic change like intradialytic hypotension.

So, the most likely explanation for these symptoms in this context is hypotension due to fluid removal during dialysis.