Peritoneal dialysis is a semi-permeable membrane between peritoneal dialysate capillary water and solute exchange , electrolytes and small molecules from the high concentration side to the low side of the mobile ( the dispersion effect ) , the water molecules low osmotic concentration of high concentration side to side to move penetration ( penetration ) . Improve dialysate concentration can be achieved to remove the body of water purposes. By solute concentration gradients uremic substances in the blood can be removed from the dialysis fluid , electrolyte and acid-base balance and maintain , instead of part of the kidney function .
The basic principles of peritoneal dialysis fluid formulations :
( 1 ) must be strictly sterile dialysate water and endotoxin .
( 2 ) dialysate with normal plasma electrolyte concentrations similar clinical conditions and may be adjusted .
① sodium ion concentration is 132mmol / L, slightly lower than the normal plasma concentrations conducive to correct the failure and renal sodium retention ;
② the concentration of chloride ion 103mmol / L;
③ the concentration of calcium ion 1.25 ~ 1.75mmol / L;
④ magnesium ion concentration is 0.25 ~ 0.75mmol / L.
Dialysate potassium ion is generally not conducive to rid the body of excess potassium , to maintain normal serum potassium concentrations , but hypokalemia , potassium temporarily added in the dialysate , the peritoneal dialysate per liter of 10% KCl 3ml, the potassium ion concentration near 4mmol / L.
( 3 ) dialysate concentration is generally slightly higher than plasma osmolality , help clear the body of water , it can be left in accordance with the degree of body water retention appropriate increase in osmotic concentration dialysate . At present, many maintain osmotic concentration of glucose , usually with 1.5% glucose peritoneal dialysis solution as the basis of its osmotic concentration of 346mOsm / L; For increased body water clear , 2.5% of the available glucose concentrations. Per liter of dialysis solution every 1% increase in glucose concentration may increase osmolarity 55mOsm / L. Existing peritoneal dialysate maximum glucose concentration of 4.25 %, the highest concentration of osmotic 490mOsm / L ( or generally not used once a day ) , unless severe acute pulmonary edema or edema to avoid the use of high glucose concentrations in order to avoid excessive dehydration, causing severe hyperglycemia and high glucose peritoneal ultrafiltration resulted in the loss of peritoneal function .
( 4 ) the peritoneal dialysate pH is 5.0 ~ 5.8 . Currently are lactate as a base , after it enters the body by the liver to bicarbonate ions.
Indications
( 1 ) acute renal failure .
( 2 ) chronic renal failure.
( 3 ) acute intoxication of drugs or poisons .
( 4 ) refractory heart failure.
( 5 ) refractory edema.
( 6 ) electrolyte imbalance and acid-base balance .
Adverse reactions
Peritoneal dialysate common adverse reactions are:
( 1 ) dehydration.
( 2 ) hypokalemia.
( 3 ) hyperglycemia .
( 4 ) hyponatremia , hypochloremia , metabolic alkalosis.
( 5 ) chemical peritonitis .
Taboo
( 1 ) extensive adhesions and intestinal obstruction.
( 2 ) severe respiratory insufficiency .
( 3 ) extensive abdominal skin infections .
( 4 ) abdominal surgery within three days , and the abdomen by surgical drainage .
( 5 ) disorders of the blood vessels within the abdominal cavity.
( 6 ) intraperitoneal huge tumors, polycystic kidney disease and so on.
( 7 ) High catabolism by .
( 8 ) have been unable to eat enough protein and calories were .
( 9 ) hernia repair were not .
( 10 ) uncooperative or mentally ill.
[Note]
( 1 ) or multiple daily poured released peritoneal dialysis fluid, peritoneal dialysis should be strictly in accordance with routine aseptic technique.
( 2 ) pay attention to water , electrolytes, acid-base balance.
( 3 ) to peritoneal dialysis dialysate containing 1.5 % ~ 2.5 % glucose mainly poor can only intermittent ultrafiltration with 4.25% ; diabetes blood glucose levels should be closely observed .
( 4 ) The remaining liquid can not be reused.
( 5 ) If a longer time for the FDA, should avoid peritoneal ultrafiltration failure , and should be prescribed potassium.
( 6 ) This product can not be used for intravenous injection.
( 7 ) If the hepatic dysfunction , should not be used peritoneal dialysis solution containing lactate .
( 8 ) as far as possible without hypertonic dialysate to avoid hyperglycemia and excessive protein loss .
Before ( 9 ) Use should be heated to about 37 ℃; and dialysate should be checked for leaks , particulate matter and discoloration floc , turbidity , etc.
Under ( 10 ) In general, are not free to add to the peritoneal dialysate drugs ; special circumstances do change according to the disease -treatment , but should be taken to avoid stimulating the peritoneum.
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