Do you adjust bicarbonate concentration of dialysate for each patient ? if yes , how ?
The concentration of bicarbonate in the dialysate should be about 32 mmol/l to get a normal concentration of bicarbonate in blood. If the patient has particular problems an adjustment can be made by oral supplements or adjusting the bicarbonate concentration in dialysate.
Guidelines suggest to have predialysis serum HCO3 > 22
There are no evidences that adjusting bath HCO3 have effect on morbility and mortality (please see Tentori's paper on AJKD )
Bon iorno @Marco Marano, and thank you very much for your comment: We really did never change or adjust the standard bicarbonate concentration in dialysate.
Buongiorno Josef
Firstly I try to understand what acid-base derangement, if any, occurs in my hemodialysis patient, than i adjust bath HCO3 according to AB disturbance, not to serum HCO3 concentration. This is because a very large and unexpected prevalence of respiratory acid-base disorders exists in my population
marco
I agree (except that severe and unexpected respiratory acid-base disorders in my earlier experience were rare).
I full agree with you. I found 40 % prevalence of respiratory disorders not severe but able to affect serum HCO3
Some years ago several ARREST CARDIAC ocurred in patients on Hemodialysis using a bag of Bicarbonate that elevated de final concentration of serum bicarbonate to 42- 45 meq/ L producing acute metabolic alkalosis, respiratory depression , cardiac arrest and death. After revision of the concentration the problem was reverted . A question is a very high level of bicarbonate generated by the bag of bicarbonate MORE the bicarbonated generated by the ACETIC ACID from the concentrated Acid : 38 - 40 mEq/L from the bag MORE 5 after the transformation of acetic acid in bicarbonate .
Patients whit DBPOC / pulmonary fibrosis are prone to suffer this consequences because tolerate very bad the alkalosis metabolic induced by high level of bicarbonate . Some patients need the use of a final bicarbonate of 28 - 30 mEq/L to obtain a secure session if have DPOC / fibrosis pulmonary.
thanks to all
Dear Marco
1- is there any guideline for sodium bicarbonate tabs ?
2- as i know oral bicarbonate has some GI problem is it right ? also the hemodialysis patients have to use many pills so is'nt it better to use bicarbonate concentration to adjust the serum bicarbonate in the safe limitation (
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