Health Worlds

Key words Hemodialysis
Abstract Objective To observe the rescue uremic hemodialysis patients with severe metabolic acidosis effect. Method of blood pH,ZHUMing-jiu, JIAO Quan, YANG Ai.Department of Nephrology, Huainan Eastern Hospital of Oriental General Hospital, Huainan232001, China
Abstract Objective To investigate the effect of hemodialysis for uremic paticnts complicated with severe metabolic acidosis.Methods Bicarbonate hemodialysis was applied for21uremic patients with acidosis (pHWater, electrolyte disorders and acid-base imbalance, metabolic acidosis of chronic renal failure is a common complication of uremia. Metabolic acidosis is a major cause harm to the cardiovascular system and central nervous system dysfunction, can produce fatal ventricular arrhythmia, myocardial contraction is reduced and the reduced catecholamine response, particularly if severe acidosis can not be quickly where can lead to death [1]. Hemodialysis (HD) is an important means of treatment of uremia, its role is to help discharged patients with metabolic toxins and excess water, maintain homeostasis, but to prevent the complications of uremia. With severe acidosis, and more important. This observation of the HD treatment 21 patients with severe uremia and metabolic acidosis (blood pH1 Materials and Methods
1.1 General Information The set of data from our hospital 4 years (February 2001 ~ February 2005) admitted with severe uremia and metabolic acidosis (blood pH707.2 mmol / L, 2


8.6mmol / L, blood pH value
1.2 Methods All patients were given oxygen to breathe rapidly and urgently HD treatment, with the German B. BraunHD machine; carbonate dialysis; dialysis blood flow of 180 ~ 280ml/min, dialysate flow 500ml/min, with hyperkalemia were given calcium agents, insulin adjuvant therapy. 1 case of dyspnea were given mechanical ventilation. 2 cases of blood pressure
Before treatment, HD and HD during the end of 2h to do blood gas analysis, renal function and electrolytes checked.
Data are expressed as mean standard deviation, dialysis, dialysis before the end of discrimination between groups using chi-square test, P
HD 21 cases of uremic patients before the blood gas analysis: pH6.5 ~ 7.0; HCO 3 - 7.8 ~ 14.0mmol / L; PCO 2 3.59 ~ 6.94kPa. The HD after the blood gas analysis, renal function and electrolytes in Table
After the emergency line HD2.5 ~ 3.0h, after all patients through the HD disease gradually ease. Significant improvement in metabolic acidosis, hyperkalemia were corrected, blood urea nitrogen, creatinine decreased compared with the predialysis differences were significant. However, decrease in blood pressure occurred during dialysis to 90/60mmHg the following 3 cases, 2 cases of gastrocnemius muscle cramps, disequilibrium syndrome, 2 cases after symptomatic treatment gradually ease.Human body through the body buffer system, lung and renal acid-base balance regulation, in which H and renal reabsorption of the exhaust of HCO 3 -, discharge phosphate, ammonium salt to regulate the discharge of acid-base balance. Chronic renal failure, excretion of acidic metabolites barrier function of renal tubular defects and renal tubular secretion of H NH 4 poor ability to manufacture, resulting in acidosis, when the glomerular filtration rate (GFR) decreased to 20ml/min, the body Start a mild metabolic acidosis, manifested as HCO 3 - concentration was decreased. When the further decline of renal function and urinary row H reduced further aggravate acidosis [2]. However, because diagnosis is not timely, or drug efficacy in patients with poor or unwilling to accept for various reasons, dialysis treatment, often resulting in severe metabolic acidosis. Severe acidosis great harm on the body, can affect multiple organ dysfunction [3]; can cause changes in vital signs, directly leading to death.
Uremic patients are often accompanied by excessive volume load and heart failure, only received compensation before alkali treatment, it may aggravate heart failure [4]. HD can be effective only through the correction of metabolic acidosis. In severe metabolic acidosis, the rapid correction of alkali acid supplement may be due to "BBB" increase "relative cerebral acidosis" will cause the corresponding neurological symptoms. In this group of patients was observed only in one case after dialysis increased by psychiatric symptoms, which may be related to the dialysis process HCO 3 - although at the beginning of the dispersion and rapid, but still at a low level, and in the back of the dialysis process the increases were slower on. Because HD's correct acid base process and the vein directly to make different, HD dialysate when the HCO 3 - diffuse into the blood through dialysis membranes, when the dialysis membrane on both sides gradually close to the concentration gradient, HCO 3 - also will be the dispersion slow down. HD can also remove other organic acids, and by excessive dehydration reduce the heart before and after the load. Cases of successful treatment in this group, after HD, in patients with metabolic acidosis improved quickly in the blood pH value rose to normal or near normal cardiac function improved significantly.
Uremic metabolic acidosis associated with intracellular to extracellular shift of potassium; patients with decreased urine output, the body be reduced emission of potassium, may cause elevated serum potassium [5]. Hyperkalemia can lead to cardiac arrhythmia, severe Aspen syndrome can occur, even death. The patients in 6 patients, hyperkalemia, including 3 cases of arrhythmia. HD patients with the acute serum potassium decreased, cardiac arrhythmia better. HD can quickly clear that the blood potassium, and bicarbonate dialysate into the blood plasma, to correct acidosis, promote transfer of potassium ions to cells, from reducing the role of potassium.
Application of bicarbonate dialysate, can effectively supplement the HCO 3 -, but may also aggravate hypocalcemia [6]. The patients in the 2 cases occurred during the gastrocnemius muscle spasm dialysis. Therefore, calcium should be added before dialysis, to prevent seizures caused by hypocalcemia. Associated with hyperkalemia on when intravenous calcium should be given time to antagonize the inhibitory effect of potassium on myocardial, prevent or correct the arrhythmia. The patients were 6 cases of hyperkalemia in the emergency intravenous calcium before HD and intravenous insulin and glucose, and quickly HD, were rescued.
HD can be quickly and effectively to treat uremia and severe metabolic acidosis and hyperkalemia, improve heart function, care should be to add calcium to prevent hypocalcemia, unstable vital signs before dialysis were rescued in time, can guarantee dialysis treatment success.1 LIN Shan-yan. Contemporary Nephrology. Shanghai: Shanghai Science and Technology Education Press, 2001,77
2 Wang Haiyan. Nephrology, 2nd Edition. Beijing: People's Medical Publishing House, 1985,139
3 Zhao Suyun, in Guizhou, Jiang Wenyong. HD uremic patients on the improvement of metabolic acidosis. Guiyang Medical College, 2004,29 (1): 8
4 Shi Kam governance, Chen Bin card, Pei-Sheng Lin. The clinical application of acute HD. Chinese Journal of Critical Care Medicine, 2001,3 (8): 18
5 Thomas D, DuBose JR.Clinical and laboratory parameters in acidbase disorders.In: Brenner BM.Brenner


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