Dialysate Composition and Chemistry Flashcards

What is the primary safety risk if chloramines are not adequately removed from dialysis water?

Answer: Hemolytic anemia from chloramine crossing the dialyzer membrane and destroying red blood cells

Chloramines pass freely through dialyzer membranes, entering the bloodstream and oxidizing red blood cell membranes, causing hemolysis and potentially fatal anemia.

Which dialysate electrolyte change can precipitate dangerous cardiac arrhythmias, particularly in digitalized or hypokalemic patients?

Answer: Rapid reduction of serum potassium by using very low (0–1 mEq/L) dialysate potassium

Aggressive potassium removal with very low dialysate potassium creates a rapid intradialytic fall in serum potassium, which is a major trigger for ventricular arrhythmias.

The dialysate temperature is typically set between:

Answer: 35–37°C to match or slightly approximate body temperature

Dialysate temperature of 35–37°C optimizes patient comfort and hemodynamic stability, with cooler temperatures sometimes used to reduce intradialytic hypotension.

What is the effect of increasing dialysate bicarbonate concentration above normal physiologic levels?

Answer: Post-dialysis metabolic alkalosis, which can worsen respiratory depression and cause hypocalcemia-related symptoms

Excessive bicarbonate transfer overcorrects acidosis, causing alkalosis that shifts calcium into the ionized-to-bound ratio, triggers tetany, and may suppress respiratory drive.

Why is magnesium included in the acid concentrate for hemodialysis dialysate?

Answer: To replace magnesium removed during dialysis and prevent hypomagnesemia, which can cause cardiac arrhythmias and neuromuscular irritability

Dialysis removes magnesium; including a physiologic level in dialysate replaces losses and maintains normal serum magnesium to prevent cardiac and neuromuscular complications.

What concentration of dialysate potassium is typically used for patients with pre-dialysis serum potassium above 6.0 mEq/L?

Answer: 1–2 mEq/L to enhance potassium removal while monitoring closely for arrhythmias

A low dialysate potassium of 1–2 mEq/L maximizes potassium removal in hyperkalemic patients, but cardiac monitoring is essential because the steep gradient increases arrhythmia risk.