<s>[INST] Hello, My dad recently dx with ESRD, started dialysis a week ago. He has comorbidties, CHF, DM, MI(3 weeks ago). Need angio, unable to have this done because he of fluid retention. He has had 18L of fluid pulled off over the past 2.5 weeks. He is having such extreme abdominal cramping x 5 days. Abd. Exray -, labs stable. He has had a productive cough x 1 week. No cx done. I m in Vegas, my parents are in MI. I just left 1.5 weeks ago. He s worsening, I m a nurse, I think he s dying am I over reacting? Do I need to go back? What are possible reason for abdominal spasm? I ve seen patients respond this way as the body adjust to major fluid shift. I m so uncertain. I just need a clue, please advise. Thanks [/INST] **1. People with ESD and having diabetes and undergone dialysis can have possible complication of hyperosmolar state and/or infection [peritonitis] which can be possible causes of abdominal spasm.2. Since MI [myocardial infarction] CHF [congestive heart failure] are example of hyper catabolic conditions thus could be associated factor for abdominal spasm3. Attending Doctor(s) are in better position to evaluate the cause and condition. [since ABD. X-ray and Lab investigations came normal] </s>