What is the optimal bicarb bath for HD in a ESRD patient who has a serum bicarb of 10 from missing 1-2 session of HD. Not septic, lactic acid and ketones normal.
Will using 35 bicarb bath in such patient (400/800x4hours) increase risk of arrythmias because of rapid correction of acidosis? Keeping in mind that if we use 25 bicarb bath, his acidosis may only partially correct.
It has been recommended that the bicarbonate bath be adjusted to correct the predialysis serum bicarbonate concentration to prevent complications related to metabolic acidosis. A U-shaped relationship exists between the predialysis serum bicarbonate concentration and mortality in ESRD patients on dialysis. A study reported that those with a bicarbonate concentration < 18 mmol/L and > 27 mmol/L are at greatest risk. However, the study also reported that after adjustment for confounding factors such as nutritional status and inflammation, only a low pre-dialysis bicarbonate concentration remained a significant risk for death. The sweet spot for the predialysis serum bicarbonate seems to be from 18-23 mmol/L. So to answer your question, get the serum bicarbonate above 17 mmol/L using the 35 mmol/L bath.
See the following paper: Article Very Low and High Predialysis Serum Bicarbonate Levels are R...