Tuesday, April 19, 2011

TOPIC DISCUSSION: Hypophosphatemia in Nocturnal hemodialysis

Hypophosphatemia is observed in patients undergoing nocturnal hemodialysis. 
Why is that? Phos is usually an intra cellular element. When we do regular 3-4 hours of HD, the extraceullar Phos is removed and the intracellular equilibrates and things are in good balance. When things are prolonged in terms of hours ( for the better) in nocturnal HD, there is actually depletion of Phos( seen also in CVVHDF). Many times, this has to be repleted back to the patient to prevent respiratory complications. Phosphate is commonly added to the dialysate acid bath, but systematic evaluation of the safety and reliability of this strategy is lacking. The study linked below looked at the addition of fleet enema to the solution.  They added serial aliquots of enema to 4.5 L of dialysate acid concentrate and proportioned the solution on Gambro and Althin/Baxter dialysis machines for up to 8 hours. Then, the dialysate phosphate, Ca, pH, and bicarbonate concentrations at baseline, and after simulated dialysis at 4 and 8 hours was measured.  For every 30 mL of Fleet® (1.38 mmol/mL of phosphate) enema added, the dialysate phosphate concentration increased by 0.2 mmol/L. There were no significant changes in dialysate phosphate, Ca, pH, and bicarbonate concentrations over 8 hours.  Bacterial and endotoxin testing met sterility standards. The addition of Fleet enema to dialysate increases phosphate concentration in a concentration prediction as depicted above.

Image source: periodicfun.wikispaces.com

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