Five different compositions of dialysate were applied to 184 hemodialysis for 14 patients in the terminal stage of chronic glomerulonephritis.
Dialyser is Kolff type Twin Coil exclusively and in five groups of dialysates, compositions are mainly different in the glucose concentration, prescribed 0.4, 0.6, 0.9, 1.4 and 2.0% respectively.
Sodium concentration is 126mEq/L in one group and 135mEq/L in others.
Bicarbonate source was sodium acetate (35-36.6mEq/L) in four groups and sodium bicarbonate (24mEq/L) in one.
Laboratory investigations were made for blood chemical change, blood glucose, serum osmolarity and acid-base balance during hemodialysis.
Clinical manifestations were recorded carefully in each dialysis.
Results are as follows;
1. Blood chemical changes including BUN, Creatinine, Na, K, Cl, Ca and inorg. P were studied. Initial level of N-end products in five groups were in the range of 80-130mg/dl in BUN and 13-14mg/dl in Creatinine. They fell about 50% in BUN and 40% in Creatinine similarly in each group.
2. Acid-base balance study revealed low pH, low pCO
2 and negative base excess, indicating metabolic acidosis with compensatory respiratory alkalosis, in every group before hemodialysis. At the end of 6hrs. dialysis, mild respiratory alkalosis was presented. In five groups, no difference was shown.
3. Blood glucose level during hemodialysis revealed prominent difference in five groups. In two groups, 0.4 and 0.6% glucose concentration dialysates, there were no change in arterial blood glucose during hemodialysis. In 0.9 and 1.4% groups, blood sugar rose in the first 2hrs., but did not exceed 300mg/dl. The last group, 2.0%, blood glucose elevated gradually and at the end of 6hrs. hemodialysis, 500mg/dl was reached.
4. Serum osmolarity fell in two groups (0.4 and 0.6%), but in those groups in which blood glucose elevation were shown, serum osmolarity did not fall to such a level as expected by the removal of BUN.
5. Clinical manifestations, especially so called “Disequilibrium syndrome”, were carefully recorded. 184 cases were analysed in two groups according to the difference shown in blood glucose level, one is 0.4-1.4% glucose concentrations in rinsing fluids and the another is 2.2%.
Although general fatigue and headache appeared in 25-30% of both groups, nausea and vomiting decreased in frequency and severe symptoms such as convulsion, coma and even death were never seen in the latter.
From these data described, we conclude blood glucose change during hemodialysis play an important role in one of many factors, contributing to the pathogenesis of disequilibrium syndrome.
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