title: Approach to the hemodialysis patient with an abnormal serum bicarbonate concentration.
abstract: We present a patient receiving hemodialysis with a persistently high serum bicarbonate concentration to illustrate the evaluation and management issues for patients with both high (>25 mEq/L) and low (<20 mEq/L) pretreatment values. Patients with high serum bicarbonate concentrations typically are malnourished and have low rates of endogenous acid production. Evaluation should begin with assessment of whether an acute and potentially reversible cause of metabolic alkalosis is present. If not, management should be directed at treating malnutrition. By contrast, patients with low predialysis serum bicarbonate concentrations, in the absence of an acute and reversible cause, may benefit from increasing the level by an adjustment in dialysate bicarbonate concentration. However, the level at which one should intervene and to what extent serum bicarbonate concentration should be increased are unresolved issues. Whether such an intervention will reduce mortality risk has not been determined.
authors.affiliation: University of Vermont College of Medicine, Burlington, VT.
authors.forename: Panupong
authors.initials: P
authors.lastname: Lisawat
authors.affiliation: University of Vermont College of Medicine, Burlington, VT. Electronic address: fgennari@uvm.edu.
authors.forename: F John
authors.initials: FJ
authors.lastname: Gennari
mesh_terms: D000136:Acid-Base Equilibrium / Q000502:physiology; D000368:Aged; D001639:Bicarbonates / Q000097:blood*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000503:physiopathology / Q000628:therapy*; D044342:Malnutrition / Q000097:blood / Q000150:complications; D006435:Renal Dialysis; D013997:Time Factors
chemical_list: D001639:Bicarbonates
keywords: Hemodialysis; acidosis; alkalosis; malnutrition; mortality; serum bicarbonate concentration