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Dialysis, Severe Acidosis, Hepatorenal Syndrome, No Cardiac Stability.

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Posted on Tue, 29 May 2012
Question: Im a new acute dialysis nurse. I want to know why a nephrologist would order a 4k bath on a new aki pt. with a k+ level of 5.5. The doctor says because of severe acidosis. This pt has hepatorenal syndrome, and no cardiac instability. I dont understand the rationale??
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Answered by Dr. Dilip M Babu (41 hours later)
Hello,

Thanks for the query.

In patients with severe Acidosis, potassium will shift from intracellular compartment to extracellular fluid so potassium level will be falsely high.

If such patients undergo dialysis, which will correct Acidosis rapidly due to bicarbonate in dialysis solution and extracellular potassium will shift back to intracellular compartment and patient will develop Hypokalemia.

Hence we advice 4K bath to avoid Hypokalemia during dialysis.

This is not a routine therapy done during Acidotic states, it is generally done in advanced renal centres. I am not doing it at my centre.

Hope I have answered your query. I will be available for follow up queries if any.

Regards,
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Above answer was peer-reviewed by : Dr. Shanthi.E
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Dr. Dilip M Babu

Nephrologist

Practicing since :2000

Answered : 11 Questions

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Dialysis, Severe Acidosis, Hepatorenal Syndrome, No Cardiac Stability.

Hello,

Thanks for the query.

In patients with severe Acidosis, potassium will shift from intracellular compartment to extracellular fluid so potassium level will be falsely high.

If such patients undergo dialysis, which will correct Acidosis rapidly due to bicarbonate in dialysis solution and extracellular potassium will shift back to intracellular compartment and patient will develop Hypokalemia.

Hence we advice 4K bath to avoid Hypokalemia during dialysis.

This is not a routine therapy done during Acidotic states, it is generally done in advanced renal centres. I am not doing it at my centre.

Hope I have answered your query. I will be available for follow up queries if any.

Regards,