for example for a patient with bicarbonate level of 9 mmol and pH 6.80 how many bicarbonate profile can be useful and safe?
In the case of HCO3 < 10 you need to start hemodialysis with Very Low [HCO3] in bath to avoid quick pH arising
Please note if HCO3 is 9 and pH is so low, then pCO2 is much higher than you expect. Therefore that patient also has ventilatory incomplete compensation. this helpfull occurence avoids quick pH arising along dialysis session
Dear Ramin, I think that your question is not easy to answer without other parameters of ABG and the underlying eatiology of the acidosis.
Usually CKD patients present with high ion gap metabolic acidosis and many experts recommend to treat the cause of acidosis rather than using alcalinisation. In any case rising rapidly the patient's bicarb level during the first dialysis hour can be deleterous.
In one paper by US Noh et al (Electrolyte and Blood Pressure, 2007) they reduced safely the dialysate bicarbonate level up to 25 mEq/L in hemodialysis patients with severe metabolic acidosis.
I would just advice (in case of any other dialysis indication) to raise your patient's pH progressively using other classical methods and to go for hemodialysis once you are near 20 mmol/l of serum bicarbonate.
Dear Sidy
I fully agree with you. Can you share with me the paper by Noh et al. published on electrolyte and blood pressure 2007 ?
My email address is [email protected]
Thanks in advance
Marco
dear sidy
I agree and need the paper too if it is possible for you .
my email address is [email protected]
regards