Hypopnea Associated with Acetate Hemodialysis: Carbon Dioxide-Flow-Dependent Ventilation

Dolan, Martin; Whipp, Brian J.; Davidson, Warren D.; Weitzman, Richard E.; Wasserman, Karlman

doi:10.1056/nejm198107093050204

Cited by 131 publications

(84 citation statements)

References 8 publications

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“…However, it was demonstrated that it could also be observed in dialysate with bicarbonate. Dialysate with acetate may induce hypoxia in two ways, first by increased oxygen consumption during acetate bicarbonate conversion and second by intradialytic loss of CO 2 (Dolan et al,1981;Oh et al,1985). The biocompatibility of the membrane used is one of the most frequently blamed factors in hypoxemia (Graf et al,1980).…”

Section: Hemodialysis-related Hypoxemiamentioning

confidence: 99%

Acute Complications of Hemodialysis

Özkan¹,

Ulusoy²

2011

Technical Problems in Patients on Hemodialysis

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Section: Hemodialysis-related Hypoxemiamentioning

confidence: 99%

Acute Complications of Hemodialysis

Özkan¹,

Ulusoy²

2011

Technical Problems in Patients on Hemodialysis

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“…b. Hipoventilación por hipocapnea secundaria al consumo de CO2 durante el metabolismo del acetato en el parénquima hepático y musculatura estriada (1). c. Disminución de la capacidad de intercambio gaseoso de la membrana alveolar por secuestro pulmonar de neutrófilos, inducido por activación de la cascada del complemento por membranas no-biocompatibles (3,4,6,19,20,21).…”

Section: Discussionunclassified

Evolución de los gases arteriales durante hemofiltración venovenosa con filtros AN-69, en pacientes críticos

Estremadoyro¹,

Miyahira²

2013

Rev Med Hered

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Evolución de los gases arteriales durante hemofiltración venovenosa con filtros AN-69, en pacientes críticos Evolution of the arterial gases during vein to venous hemofiltration with AN-69 filters in critically ill patients ESTREMADOYRO Luis, MIYAHIRA Juan SUMMARY In Peru, we have only acetate hemodialysis. Complications associated with acetate hemodialysis include hypoxemiaand imparirment of metabolic acidosis, these reach its lower point at one hour the of starting procedure. They constitute a disadvantage in the management of inestables or critical patients. In order to describe the evolution of arterial gas an acid-base states during venovenous hemofiltration (VVHF), we evaluated eight procedures realized in equal number of patients with uremia or acute pulmonar edema. The replacement solution was Ringer´s lactate. Neither hypoxemia, not variations in arterial pH or serum bicarbonate did occur during VVHF. We feel that hemofiltration is better alternative in the management of inestable or critical patients who require dialytic support. (Rev Med Hered 1994; 5: 33-37).

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“…Sodium acetate has fallen into disuse as a dialysate buffer due to adverse events associated with its administration, including myocardial depression, hypotension, and hypopnea resulting in hypoxemia [22][23][24]. Sodium acetate, when given in excess during dialysis, is funneled to alternative metabolic pathways, leading to increased nitric oxide concentrations and resulting hemodynamic instability [25].…”

Section: Adverse Events From Sodium Acetatementioning

confidence: 99%

“…Sodium acetate dialysate buffer, when compared head-to-head with sodium bicarbonate dialysate, consistently lowers SVR [27,28]. Hypopnea, often in the setting of hypoxemia during dialysis with sodium acetate, may arise from loss of carbon dioxide in the absence of a bicarbonate buffer; chemoreceptors then recognize serum hypocarbia and reduce respiratory drive [22]. More recent observations include flushing reactions when sodium acetate is given by intravenous bolus; this may also represent increases in nitric oxide production arising from saturated metabolic pathways of sodium acetate.…”

Section: Adverse Events From Sodium Acetatementioning

confidence: 99%

Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review

et al. 2013

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Sodium bicarbonate is central to the treatment of many poisonings. When it was placed on the FDA drug shortage list in 2012, alternative treatment strategies to specific poisonings were considered. Many hospital pharmacies, poison centers, and medical toxicologists proposed sodium acetate as an adequate alternative, despite a paucity of data to support its use in medical toxicology. The intention of this review is to educate the clinician on the use of sodium acetate and to advise them on the potential adverse events when given in excess. We conducted a literature search focused on the pharmacology of sodium acetate, its use as a buffer in pathologic acidemia and dialysis baths, and potential adverse events associated with excess sodium acetate infusion. It appears safe to replace sodium bicarbonate infusion with sodium acetate on an equimolar basis. The metabolism of acetate, however, is more complex than bicarbonate. Future prospective studies will be needed to confirm the efficacy of sodium acetate in the treatment of the poisoned patient.

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Hypopnea Associated with Acetate Hemodialysis: Carbon Dioxide-Flow-Dependent Ventilation

Cited by 131 publications

References 8 publications

Acute Complications of Hemodialysis

Acute Complications of Hemodialysis

Evolución de los gases arteriales durante hemofiltración venovenosa con filtros AN-69, en pacientes críticos

Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review

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