Hello,

There is a risk that very rapid drops in potassium can precipitate arrhythmia. However, severe hyperkalemia is an emergency itself and so we generally would dialyze with a potassium concentration of 2 mmol/L.


Dr. Jordan Weinstein

Thanks for the reply i understood the reason what about the Calcium concentrate in the dialysate? Is it important too?
Can you please give me an evidence where it is stated as such so i can read up more.

Good;
For calcium I put a bath 1.75, it seems that it helps to preserve the hemodynamic state

Hi Anusha-As far as dialysate [K] is concerned, as a rule of thumb I use this formula: Dialysate [K] = 8 - Predialysis [K]
e.g. if patient's serum [K] (predialysis) is 5 mmol/L then dialysate [K] should be 3 mmol/L
if patient's serum [K] (predialysis) is 7mmol/L or above then dialysate [K] should be 1 mmol/L

Note: slightly HIGHER dialysate K would be more appropriate if patient is on Digitalis (digoxine)
Interestingly if you use low glucose/dextrose dialysate ( 5.5 mmol/L instead of 11 mmol/L) the post dialysis K would be lower (less intracellular shift hence more efficient K removal), so if you specifically have problem with high K in a patient, then that would help. Again patients with sepsis and on beta blocker are prone to hypoglycaemia.

Regarding dialysate Calcium: 1.5 mM/L (3 meq/L) is our standard specially in acute setting when patients are severely acidotic. In moderate to severe hypercalcaemia we use 1.25mM(2.5meq/L).

I hope this makes sense.

Soroush