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What is Hemodialysis?
Shahrzad Ossareh-M.D.
300-500 ml/min
500-800 ml/min
Diffusion
Convection
Arterial line Venous line
Dialysis Solution
Component Concentration (meq/L) Na 135-145 K 0-4 Ca 2.5-3.5 Mg 0.5-0.75 Cl 98-124 Acetate 2-4 Bicarbonate 30-40 Dextrose 11 PCO2 40-110 pH 7.1-7.3
The acetate is in the form of acetic acid in the acid component. On mixing with the HCO3 component the H+ in acid acetic reacts with an equimolar amount of HCO3 to form CO2
Complications During HD: Hypotension
Decreased Blood
Volume:
High UF rate,
Low dialysate Na
Lack of vasoconstriction:
Acetate dialysate
Warm dialysate
Food ingestion
Tissue ischemia
Autonomic neuropathy
Antihypertensives
Cardiac factors: Diastolic dysfunction β-blockers Uremic autonimc
neuropathy Aging Poor myocardial
contractility Pericardial Tamponade MI Occult Hemorrhage Septicemia Dialyzer Reaction Hemolysis Air Embolism
Other Complications: Muscle cramps
Hypotension Patient below dry weight Low dialysate Na Chronic leg cramps Nausea and vomiting
Chest pain and back pain Itching Fever and chills Disequilibrium syndrome Dialyzer reactions
Type A: Anaphylactic type: E.O., AN 69, PAN, contaminated dialysis solution, reuse, heparin
Type B: Complement activation, less severe Arrhythmia, Tamponade, IC bleeding, Seizures, Hemolysis,
Air embolism, Neutropenia and complement activation
KT/V=1.4
60 kg female V= 60 0.55= 33 L = 33,000 ml T= 4 hours = 240 min K ? KT/V=1.4 → (K 240 )/33,000 = 1.4 → K 240 = 46,200 → K = 192.5 (PS13)
Peritoneal DialysisPeritoneal Dialysis
Definition
The transport of solutes and water across a membrane that separates 2 fluid containing compartments: Blood in the peritoneal capillaries Dialysis solution in the peritoneal
cavity
Stagnant fluid film over the endothelium
of peritoneal capillary walls
Capillary endothelium
Stagnant fluid filmoverlying
the peritoneal membrane
Endothelial B.M.
Mesothelium
Interstitium