Friday, 06 December 2013
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In performing first acute haemodialysis, what should be the concentration of the potassium and calcium in the dialysate? Concentrate of 3K is used for all first acute dialysis patients irrespective of their Calcium level in some centres. I was told that a drastic drop in potassium could endanger the patient. Is this true? For example, if a patient comes with a Potassium of 7 and Calcium of 2.8. What should be dialysate concentrate value? Please explain if anyone can help me with this

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
7 years ago
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.
7 years ago
For calcium I put a bath 1.75, it seems that it helps to preserve the hemodynamic state
7 years ago
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.

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