Acid-base derangements during sorbent regenerative hemodialysis in mechanically ventilated patients.
OBJECTIVE
To assess acid-base derangements during sorbent regenerative hemodialysis in mechanically ventilated patients.


METHODS
Consecutive case series; prospective study.


METHODS
An ICU in a university hospital.


METHODS
Seven patients undergoing hemodialysis for acute renal failure who required mechanical ventilation for acute respiratory failure.


METHODS
Pulmonary and systemic hemodynamics, pH, and gas tensions in dialysate, arterial and mixed venous blood, and blood entering and leaving the dialyzer, were measured before, during, and after hemodialysis.


RESULTS
During the first 2 hrs of hemodialysis, dialysate pH decreased from 6.91 +/- 0.14 to 6.06 +/- 0.37 and PCO2 increased to 437 +/- 111 torr (58.2 +/- 14.8 kPa). Simultaneously, the patients lost bicarbonate into the bath. As a result, pHa decreased from 7.38 +/- 0.02 to 7.31 +/- 0.02. At the end of dialysis, pHa returned to normal.


CONCLUSIONS
Sorbent hemodialysis in mechanically ventilated patients is accompanied by acidosis that may contribute to hemodynamic instability.
Reyes
A
A
Intensive Care Unit, Hospital de la Princesa, Madrid, Spain.
Turchetto
E
E
Bernis
C
C
Cereijo
E
E
D000138:Acidosis / Q000209:etiology* / Q000517:prevention & control; D058186:Acute Kidney Injury / Q000628:therapy; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000627:therapeutic use; D002245:Carbon Dioxide / Q000032:analysis / Q000097:blood; D005260:Female; D015312:Hemodialysis Solutions / Q000737:chemistry; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy
D001639:Bicarbonates; D015312:Hemodialysis Solutions; D002245:Carbon Dioxide; D010100:Oxygen