Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
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In bicarbonate-dialysis the dialysate is acid, thus allowing salts to remain in their soluble form, as a result of the chemical reaction of bicarbonate with any acid that yields carbon dioxide (CO2). The residual anion, commonly acetate or more rarely citrate, reaches the patients' bloodstream. CO2 also spreads to the patients and ventilation needs therefore to be increased to avoid hypercapnia. ⋯ Acidosis by dialysate is characterized by respiratory symptoms first and by haemodynamic instability later, which make it look very similar to acetate intolerance. To discriminate between these two conditions, blood gas analysis is mandatory. The presence of hypercapnia can be revealed by using the Very Simple Formula (expected pCO2 = bicarbonate + 15), thus identifying those patients that may take the most advantage of AFB.