Renal Case Histories - Case 24

A 26-year-old with diabetes mellitus has developed renal failure. While waiting for a kidney transplant, he is on maintenance hemodialysis eight to ten hours three times each week. He is on a diet restricted in sodium (500 mg/day), potassium (2.6 g/day), and protein as well as his usual diabetic diet. He has a shunt in his right wrist to allow for easy hookup to the dialysis machine. Prior to hemodialysis, his representative blood values are the following:
Serum sodium 120 mEq/L
Serum potassium 6.4 mEq/L
Serum chloride 102 mEq/L
Serum creatinine 16 mg/dL
Hematocrit 24%
The dialysis fluid in the kidney dialysis machine contains the following:
Sodium 134 mEq/L
Potassium 2.6 mEq/L
Calcium 2.5 mEq/L
Magnesium 1.5 mEq/L
Chloride 104 mEq/L
Sodium acetate 36.6 mEq/L
Anhydrous dextrose 2 g/L

1. What is hemodialysis?

2. Following eight to ten hours of hemodialysis, do you think the following blood values would be increased, decreased, or remain the same? Serum sodium: Serum potassium: input name="Question2b" size=15"> Serum chloride: input name="Question2c" size=15"> Serum creatinine: input name="Question2d" size=15"> Hematocrit: input name="Question2e" size=15">

3. Why does anemia usually develop with maintenance dialysis?

4. Why is hemodialysis required every two to three days for eight to ten hours/day for individuals with complete renal failure? (Flow rate of blood through the dialyzer is 150-300 mL/min.)

5. Differentiate between hemodialysis and peritoneal dialysis.

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