Nephron. Physiology
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Nephron. Physiology · Feb 2002
Case ReportsHemodialysis is as effective as hemoperfusion for drug removal in carbamazepine poisoning.
Although most authors recommend charcoal hemoperfusion (CHP) for the removal of carbamazepine (CBZ) in acute CBZ poisoning, we present a case where we had the chance to compare CHP with hemodialysis (HD). A 50-year-old white man with normal renal function ingested an unknown quantity of CBZ with lithium. ⋯ Four hours later he also had a 3-hour CHP which further reduced his CBZ level by 25.3%. Therefore we conclude that HD with high-flux dialyzers is at least as effective as CHP for the removal of CBZ from the blood after CBZ intoxication.
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Nephron. Physiology · Jan 2002
Hemoglobin level is an important determinant of acid-base status in hemodialysis patients.
We studied the relationship between hemoglobin (Hb), which is a major buffer of blood, and arterial blood total carbon dioxide (tCO2) levels in maintenance hemodialysis (HD) patients. We also evaluated the difference between the tCO2 measured with a standard Hb value of 15 g/dl, and that assayed with an actual Hb level entered into an analyzer. ⋯ The degree of anemia and, to some extent, laboratory technique should always be considered when interpreting changes in arterial blood acid-base balance in maintenance HD patients.
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Circulating magnesium exists in the bound and in the free ionized form, that is biologically active. In kidney disease the relationship between ionized and total circulating magnesium is often altered. Little information is available on the influence of hemodialysis on the relationship between ionized and total circulating magnesium in end-stage kidney disease. ⋯ The study demonstrates a tendency towards a reduced circulating ionized magnesium fraction in end-stage kidney disease that is not corrected by hemodialysis.
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Two aspects of hypernatremia are emphasized in this discussion: pathogenesis and treatment. Hypernatremia rarely develops with increased water loss alone; there must be a mechanism that interferes with water intake. ⋯ The calculation of fluid volume needed to correct hypernatremia can be obtained with use of various formulae described here for the fluid that contains dextrose in water or for hypotonic saline solution. Accurate prediction of the fluid volume requirement demands the knowledge of urine output and its electrolyte content, but when the information is not available, urine may be assumed to be isotonic in its electrolyte content.