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Management of hypophosphatemia in nocturnal hemodialysis with phosphate-containing enema: a technical study.

机译:夜间血液透析中含磷酸盐的灌肠治疗低磷酸盐血症的技术研究。

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摘要

Hypophosphatemia is observed in patients undergoing nocturnal hemodialysis. Phosphate is commonly added to the dialysate acid bath, but systematic evaluation of the safety and reliability of this strategy is lacking. The objectives of this study were 4-fold. First, we determined whether predictable final dialysate phosphate concentrations could be achieved by adding varying amounts of Fleet(R) enema. Second, we assessed the stability of calcium (Ca) and phosphate dialysate levels under simulated nocturnal hemodialysis conditions. Third, we assessed for Ca-phosphate precipitate. Finally, we evaluated whether dialysate containing Fleet(R) enema met the current sterility standards. We added serial aliquots of enema to 4.5 L of dialysate acid concentrate and proportioned the solution on Gambro and Althin/Baxter dialysis machines for up to 8 hours. We measured dialysate phosphate, Ca, pH, and bicarbonate concentrations at baseline, and after simulated dialysis at 4 and 8 hours. We evaluated for precipitation visually and by assessing optical density at 620 nm. We used inoculation of agar to detect bacteria and Pyrotell reaction for endotoxin. For every 30 mL of Fleet(R) (1.38 mmol/mL of phosphate) enema added, the dialysate phosphate concentration increased by 0.2 mmol/L. There were no significant changes in dialysate phosphate, Ca, pH, and bicarbonate concentrations over 8 hours. No precipitate was observed in the dialysate by optical density measures at 620 nm for additions of up to 90 mL of enema. Bacterial and endotoxin testing met sterility standards. The addition of Fleet(R) enema to dialysate increases phosphate concentration in a predictable manner, and no safety problems were observed in our in vitro studies.
机译:在进行夜间血液透析的患者中观察到低磷酸盐血症。磷酸盐通常添加到透析液的酸浴中,但是缺乏对该策略的安全性和可靠性的系统评价。这项研究的目标是4倍。首先,我们确定是否可以通过添加不同量的Fleet?灌肠剂来实现可预测的最终透析液磷酸盐浓度。其次,我们评估了在模拟的夜间血液透析条件下钙(Ca)和磷酸盐透析液水平的稳定性。第三,我们评估了磷酸钙的沉淀。最后,我们评估了含有Fleet(R)灌肠剂的透析液是否符合当前的无菌标准。我们将灌肠液的等分试样添加到4.5 L的透析液酸浓缩物中,并在Gambro和Althin / Baxter透析机上称量溶液长达8小时。我们在基线时以及在4和8小时进行模拟透析后,测量了透析液中磷酸盐,钙,pH和碳酸氢盐的浓度。我们通过视觉和通过评估620 nm的光密度评估沉淀。我们使用琼脂接种来检测细菌和Pyrotell反应中的内毒素。每添加30毫升Fleet(1.38 mmol / mL磷酸盐)灌肠剂,透析液磷酸盐浓度增加0.2 mmol / L。在8小时内,透析液中的磷酸盐,钙,pH和碳酸氢盐浓度无明显变化。通过添加至多90 mL灌肠在620 nm处通过光密度测量在透析液中未观察到沉淀。细菌和内毒素测试符合无菌标准。向透析液中添加Fleet(R)灌肠剂可以预料的方式增加磷酸盐的浓度,在我们的体外研究中未发现安全问题。

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