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• W2095623896 abstract "We present a patient receiving hemodialysis with a persistently high serum bicarbonate concentration to illustrate the evaluation and management issues for patients with both high (>25 mEq/L) and low (<20 mEq/L) pretreatment values. Patients with high serum bicarbonate concentrations typically are malnourished and have low rates of endogenous acid production. Evaluation should begin with assessment of whether an acute and potentially reversible cause of metabolic alkalosis is present. If not, management should be directed at treating malnutrition. By contrast, patients with low predialysis serum bicarbonate concentrations, in the absence of an acute and reversible cause, may benefit from increasing the level by an adjustment in dialysate bicarbonate concentration. However, the level at which one should intervene and to what extent serum bicarbonate concentration should be increased are unresolved issues. Whether such an intervention will reduce mortality risk has not been determined. We present a patient receiving hemodialysis with a persistently high serum bicarbonate concentration to illustrate the evaluation and management issues for patients with both high (>25 mEq/L) and low (<20 mEq/L) pretreatment values. Patients with high serum bicarbonate concentrations typically are malnourished and have low rates of endogenous acid production. Evaluation should begin with assessment of whether an acute and potentially reversible cause of metabolic alkalosis is present. If not, management should be directed at treating malnutrition. By contrast, patients with low predialysis serum bicarbonate concentrations, in the absence of an acute and reversible cause, may benefit from increasing the level by an adjustment in dialysate bicarbonate concentration. However, the level at which one should intervene and to what extent serum bicarbonate concentration should be increased are unresolved issues. Whether such an intervention will reduce mortality risk has not been determined. Abnormal Serum Bicarbonate Concentration in Hemodialysis PatientsAmerican Journal of Kidney DiseasesVol. 64Issue 6PreviewI read with great interest the article by Drs Lisawat and Gennari,1 which presents a patient with a high predialysis serum bicarbonate concentration due to low endogenous acid production. According to the authors (and described in Box 1 of their article1), excessive alkali administration in a patient receiving hemodialysis is a cause of elevated predialysis serum bicarbonate level. They also emphasize that there is no evidence that reducing dialysate bicarbonate concentration lessens morbidity and mortality. Full-Text PDF A “Lingering Mystery” of Postdialysis Serum Bicarbonate ConcentrationAmerican Journal of Kidney DiseasesVol. 64Issue 6PreviewAfter reading Lisawat and Gennari’s1 teaching case, we would like to raise the following points. Full-Text PDF" @default.
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• W2095623896 date "2014-07-01" @default.
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• W2095623896 title "Approach to the Hemodialysis Patient With an Abnormal Serum Bicarbonate Concentration" @default.
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• W2095623896 doi "https://doi.org/10.1053/j.ajkd.2013.12.017" @default.
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