A 61-year-old woman with hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, congestive heart failure (s/p PPM/ICD), pulmonary embolism (on warfarin), end-stage renal disease (on HD via right internal jugular vein tunneled catheter), right AV fistula (s/p balloon angioplasty), left AV fistula (s/p ligation), and left brachiocephalic vein stent presented to the ED after a fall shortly after her dialysis session.

She reported lightheadedness that she said she usually experienced after dialysis, and thought it caused her fall.

The patient said she had only buttock pain, but was found to have a blood pressure of 90/40 mm Hg with normal heart rate and normal fingerstick.

Her physical exam was unremarkable. An ECG showed a biventricular paced rhythm without signs of acute ischemia, unchanged from previously.

Her hypotension resolved spontaneously during her ED visit, and a workup was significant only for an INR of 1.6.

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