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What is Hemodialysis?

What is Hemodialysis?. Shahrzad Ossareh-M.D. 300-500 ml/min. Diffusion. Convection. 500-800 ml/min. Arterial line. Venous line. 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

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What is Hemodialysis?

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  1. What is Hemodialysis? Shahrzad Ossareh-M.D.

  2. 300-500 ml/min Diffusion Convection 500-800 ml/min

  3. Arterial line Venous line

  4. Dialysis Solution ComponentConcentration (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

  5. Complications During HD: Hypotension • Cardiac factors: • Diastolic dysfunction • β-blockers • Uremic autonimc neuropathy • Aging • Poor myocardial contractility • Pericardial Tamponade • MI • Occult Hemorrhage • Septicemia • Dialyzer Reaction • Hemolysis • Air Embolism • Decreased Blood Volume: • High UF rate, • Low dialysate Na • Lack of vasoconstriction: • Acetate dialysate • Warm dialysate • Food ingestion • Tissue ischemia • Autonomic neuropathy • Antihypertensives

  6. 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

  7. 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)

  8. Peritoneal Dialysis

  9. 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

  10. Endothelial B.M. Interstitium Stagnant fluid film over the endothelium of peritoneal capillary walls Stagnant fluid film overlying the peritoneal membrane Capillary endothelium Mesothelium

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