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Acute hypernatraemia during bicarbonate-buffered haemodialysis
D J Williams1, J Jugurnauth, K Harding
1Institute of Urology and Nephrology, Middlesex Hospital, London, UK.
Summary
Acute hypernatraemia occurred in haemodialysis patients due to faulty dialysate. Correcting the sodium bicarbonate powder
Area of Science:
- Nephrology
- Biomedical Engineering
Background:
- Maintenance haemodialysis patients are susceptible to electrolyte imbalances.
- Dialysate preparation errors can lead to severe patient complications.
Observation:
- A batch of granular, less soluble sodium bicarbonate powder led to hypernatric dialysate in five haemodialysis patients.
- Powder dissolution issues caused CO2 loss, pH increase, and calcium carbonate precipitation, interfering with conductivity monitoring.
- Incorrect low conductivity readings prompted the dialysis machine to deliver excessive 'acid' concentrate.
Findings:
- Patients experienced acute hypernatraemia (158-179 mmol/l plasma sodium).
- Most patients had minimal symptoms, with one developing pulmonary oedema.
- Hypernatraemia resolved without lasting complications after correction.
Implications:
- Dialysate preparation errors, particularly with bicarbonate powder, pose a risk for haemodialysis patients.
- Standardizing bicarbonate powder particle size (≤125 microns) and dissolution methods is crucial.
- Ensuring proper powder handling and gentle dissolution can prevent conductivity errors and patient harm.