title: Severe hypotension during hemofiltration in an uremic patient with metabolic alkalosis.
abstract: We describe a case of medication induced metabolic alkalosis in a maintenance dialysis patient who developed severe hypotension while undergoing a lactate hemofiltration procedure. A 73-year-old man with ESRD due to renovascular disease was used to ingesting up to 30 grams per day of a non-prescription medication (Effervescent granulare 250 grams, CRASTAN, Pisa Italy) consisting of sodium bicarbonate, citric acid, glucose and lemon flavor. For technical problem lactate hemofiltration was performed and thirty minutes after dialysis was started a severe symptomatic hypotension occurred (blood pressure 65/35 mmHg). Lactate hemofiltration was suspended and one-hour later standard bicarbonate dialysis was performed without any clinical problem. The different mechanisms in acidosis buffering occurring in lactate and bicarbonate hemofiltration were discussed.
authors.affiliation: Department of Internal Medicine, University of Pisa, Pisa, Italy. v.panichi@int.med.unipi.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Panichi
authors.forename: Giovanni Manca
authors.initials: GM
authors.lastname: Rizza
authors.forename: Daniele
authors.initials: D
authors.lastname: Taccola
authors.forename: Cristina
authors.initials: C
authors.lastname: Consani
authors.forename: Giuliano
authors.initials: G
authors.lastname: Barsotti
mesh_terms: D000368:Aged; D000471:Alkalosis / Q000139:chemically induced*; D017583:Hemodiafiltration / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D012720:Severity of Illness Index; D017693:Sodium Bicarbonate / Q000009:adverse effects*
chemical_list: D017693:Sodium Bicarbonate