Intradialytic Hypercapnic Respiratory Failure Managed by Noninvasive Assisted Ventilation
We report a hemodialysis patient with acute hypercapnic respiratory failure managed on noninvasive intermittent positive pressure ventilation and progressive metabolic acidosis. Dialysate bicarbonate concentration of 25 mEq/l was associated with exacerbation of metabolic acidosis, while higher dialy...
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| Veröffentlicht in: | American journal of nephrology 2001-09, Vol.21 (5), p.383-385 |
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| container_end_page | 385 |
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| container_issue | 5 |
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| container_title | American journal of nephrology |
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| creator | Tovbin, David Heimer, Dov Mashal, Abdallah Degtyar, Pinchas Avnon, Lone Solling |
| description | We report a hemodialysis patient with acute hypercapnic respiratory failure managed on noninvasive intermittent positive pressure ventilation and progressive metabolic acidosis. Dialysate bicarbonate concentration of 25 mEq/l was associated with exacerbation of metabolic acidosis, while higher dialysate bicarbonate concentration of 30 mEq/l induced a dangerous increase in PCO 2 level. Excessive bicarbonate buffering and CO 2 production induced by severe metabolic acidosis, malnourishment and tissue hypoxia, could explain inadequate correction of metabolic acidosis and worsening of hypercapnia in this patient. Our findings suggest the need for close monitoring of blood gases and cautious modulation of dialysate bicarbonate concentration in the presence of progressive metabolic acidosis in hypercapnic hemodialysis patients. |
| doi_str_mv | 10.1159/000046279 |
| format | Article |
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Dialysate bicarbonate concentration of 25 mEq/l was associated with exacerbation of metabolic acidosis, while higher dialysate bicarbonate concentration of 30 mEq/l induced a dangerous increase in PCO 2 level. Excessive bicarbonate buffering and CO 2 production induced by severe metabolic acidosis, malnourishment and tissue hypoxia, could explain inadequate correction of metabolic acidosis and worsening of hypercapnia in this patient. Our findings suggest the need for close monitoring of blood gases and cautious modulation of dialysate bicarbonate concentration in the presence of progressive metabolic acidosis in hypercapnic hemodialysis patients.</description><identifier>ISSN: 0250-8095</identifier><identifier>EISSN: 1421-9670</identifier><identifier>DOI: 10.1159/000046279</identifier><identifier>PMID: 11684799</identifier><identifier>CODEN: AJNED9</identifier><language>eng</language><publisher>Basel, Switzerland: Karger</publisher><subject>Acidosis - etiology ; Acidosis - metabolism ; Adult ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Bicarbonates - metabolism ; Biological and medical sciences ; Clinical Study ; Emergency and intensive care: renal failure. Dialysis management ; Humans ; Hypercapnia - etiology ; Hypercapnia - therapy ; Intensive care medicine ; Intermittent Positive-Pressure Ventilation ; Kidney Failure, Chronic - complications ; Kidney Failure, Chronic - therapy ; Male ; Medical sciences ; Renal Dialysis - adverse effects ; Respiratory Insufficiency - etiology ; Respiratory Insufficiency - therapy ; Risk Factors</subject><ispartof>American journal of nephrology, 2001-09, Vol.21 (5), p.383-385</ispartof><rights>2001 S. Karger AG, Basel</rights><rights>2002 INIST-CNRS</rights><rights>Copyright 2001 S. Karger AG, Basel</rights><rights>Copyright S. 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Dialysate bicarbonate concentration of 25 mEq/l was associated with exacerbation of metabolic acidosis, while higher dialysate bicarbonate concentration of 30 mEq/l induced a dangerous increase in PCO 2 level. Excessive bicarbonate buffering and CO 2 production induced by severe metabolic acidosis, malnourishment and tissue hypoxia, could explain inadequate correction of metabolic acidosis and worsening of hypercapnia in this patient. Our findings suggest the need for close monitoring of blood gases and cautious modulation of dialysate bicarbonate concentration in the presence of progressive metabolic acidosis in hypercapnic hemodialysis patients.</description><subject>Acidosis - etiology</subject><subject>Acidosis - metabolism</subject><subject>Adult</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Bicarbonates - metabolism</subject><subject>Biological and medical sciences</subject><subject>Clinical Study</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Humans</subject><subject>Hypercapnia - etiology</subject><subject>Hypercapnia - therapy</subject><subject>Intensive care medicine</subject><subject>Intermittent Positive-Pressure Ventilation</subject><subject>Kidney Failure, Chronic - complications</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Renal Dialysis - adverse effects</subject><subject>Respiratory Insufficiency - etiology</subject><subject>Respiratory Insufficiency - therapy</subject><subject>Risk Factors</subject><issn>0250-8095</issn><issn>1421-9670</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNpt0N1L3TAYBvAwHPPoduG1IEVQ2EW3Nx9tmsuDqMfhHIxt4FV5k6YS7Ulr0h7of2-P50xBzE1C8uN5w0PIAYVvlGbqO0xL5EyqD2RGBaOpyiXskBmwDNICVLZL9mK8B6CsAPmJ7FKaF0IqNSO3V74PWDlsxt6ZZDF2Nhjs_HT-bWPnAvZtGJMLdM0QbPITPd7ZKtFjctN651cY3com8xhd7Kf7f9b3rsHetf4z-VhjE-2X7b5P_l6c_zlbpNe_Lq_O5tep4UXWp9RShLpSgkujGSJnXGtVSKm1rriuc2YoCptzLkFnMsPaFAVQkWfMKiOA75PTTW4X2sfBxr5cumhs06C37RBLyRgXgqoJHr-B9-0Q_PS3kvFcyZzTddrXDTKhjTHYuuyCW2IYSwrluuzypezJHm0DB7201avctjuBky3AaLCpA3rj4qsTUDCAtTvcuAcMdza8gP9jjt99nf-4eQZlV9X8CX7Lmwg</recordid><startdate>20010901</startdate><enddate>20010901</enddate><creator>Tovbin, David</creator><creator>Heimer, Dov</creator><creator>Mashal, Abdallah</creator><creator>Degtyar, Pinchas</creator><creator>Avnon, Lone Solling</creator><general>Karger</general><general>S. 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Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Bicarbonates - metabolism</topic><topic>Biological and medical sciences</topic><topic>Clinical Study</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Humans</topic><topic>Hypercapnia - etiology</topic><topic>Hypercapnia - therapy</topic><topic>Intensive care medicine</topic><topic>Intermittent Positive-Pressure Ventilation</topic><topic>Kidney Failure, Chronic - complications</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Renal Dialysis - adverse effects</topic><topic>Respiratory Insufficiency - etiology</topic><topic>Respiratory Insufficiency - therapy</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tovbin, David</creatorcontrib><creatorcontrib>Heimer, Dov</creatorcontrib><creatorcontrib>Mashal, Abdallah</creatorcontrib><creatorcontrib>Degtyar, Pinchas</creatorcontrib><creatorcontrib>Avnon, Lone Solling</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest Science Journals</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tovbin, David</au><au>Heimer, Dov</au><au>Mashal, Abdallah</au><au>Degtyar, Pinchas</au><au>Avnon, Lone Solling</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intradialytic Hypercapnic Respiratory Failure Managed by Noninvasive Assisted Ventilation</atitle><jtitle>American journal of nephrology</jtitle><addtitle>Am J Nephrol</addtitle><date>2001-09-01</date><risdate>2001</risdate><volume>21</volume><issue>5</issue><spage>383</spage><epage>385</epage><pages>383-385</pages><issn>0250-8095</issn><eissn>1421-9670</eissn><coden>AJNED9</coden><abstract>We report a hemodialysis patient with acute hypercapnic respiratory failure managed on noninvasive intermittent positive pressure ventilation and progressive metabolic acidosis. Dialysate bicarbonate concentration of 25 mEq/l was associated with exacerbation of metabolic acidosis, while higher dialysate bicarbonate concentration of 30 mEq/l induced a dangerous increase in PCO 2 level. Excessive bicarbonate buffering and CO 2 production induced by severe metabolic acidosis, malnourishment and tissue hypoxia, could explain inadequate correction of metabolic acidosis and worsening of hypercapnia in this patient. Our findings suggest the need for close monitoring of blood gases and cautious modulation of dialysate bicarbonate concentration in the presence of progressive metabolic acidosis in hypercapnic hemodialysis patients.</abstract><cop>Basel, Switzerland</cop><pub>Karger</pub><pmid>11684799</pmid><doi>10.1159/000046279</doi><tpages>3</tpages></addata></record> |
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| identifier | ISSN: 0250-8095 |
| ispartof | American journal of nephrology, 2001-09, Vol.21 (5), p.383-385 |
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| source | MEDLINE; Karger Journals Complete |
| subjects | Acidosis - etiology Acidosis - metabolism Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Bicarbonates - metabolism Biological and medical sciences Clinical Study Emergency and intensive care: renal failure. Dialysis management Humans Hypercapnia - etiology Hypercapnia - therapy Intensive care medicine Intermittent Positive-Pressure Ventilation Kidney Failure, Chronic - complications Kidney Failure, Chronic - therapy Male Medical sciences Renal Dialysis - adverse effects Respiratory Insufficiency - etiology Respiratory Insufficiency - therapy Risk Factors |
| title | Intradialytic Hypercapnic Respiratory Failure Managed by Noninvasive Assisted Ventilation |
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