What is Hemodialysis? Shahrzad Ossareh-M.D.. 300-500 ml/min 500-800 ml/min Diffusion Convection.
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Transcript of What is Hemodialysis? Shahrzad Ossareh-M.D.. 300-500 ml/min 500-800 ml/min Diffusion Convection.
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What is Hemodialysis?
Shahrzad Ossareh-M.D.
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300-500 ml/min
500-800 ml/min
Diffusion
Convection
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Arterial line Venous line
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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
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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
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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
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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)
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Peritoneal DialysisPeritoneal Dialysis
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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
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Stagnant fluid film over the endothelium
of peritoneal capillary walls
Capillary endothelium
Stagnant fluid filmoverlying
the peritoneal membrane
Endothelial B.M.
Mesothelium
Interstitium
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