As a dialysis patient, Michelle has a 4-h dialysis treatment three times a week.

Question

As a dialysis patient, Michelle has a 4-h dialysis treatment three times a week. When she arrives at the dialysis clinic, her weight, temperature, and blood pressure are taken and blood tests are done to determine the level of electrolytes and urea in her blood. In the dialysis center, tubes to the dialyzer are connected to the catheter she has had implanted. Blood is then pumped out of her body, through the dialyzer where it is filtered, and returned to her body. As Michelle's blood flows through the dialyzer, electrolytes from the dialysate move into her blood, and waste products in her blood move into the dialysate, which is continually renewed. To achieve normal serum electrolyte levels, dialysate fluid contains sodium, chloride, and magnesium levels that are equal to serum concentrations. These electrolytes are removed from the blood only if their concentrations are higher than normal. Typically, in dialysis patients, the potassium ion level is higher than normal. Therefore, initial dialysis may start with a low concentration of potassium ion in the dialysate. During dialysis excess fluid is removed by osmosis. A 4-h dialysis session requires at least 120 L of dialysis fluid. During dialysis, the electrolytes in the dialysate are adjusted until the electrolytes have the same levels as normal serum. Initially the dialysate solution prepared for Michelle's pre-dialysis blood tests shows that the electrolyte levels in her blood are HCO3 27 mEq/L, K+ 3.0mEq/L, Na+ 152 mEq/L, Ca2+ 6.0 mEq/L, Mg2+ 1.2 mEq/L, Cl 112.0 mEq/L.
A dialysis solution is prepared for Michelle that contains the following:
HCO3 35.0 mEq/L, K+ 6.0 mEq/L, Na+ 130 mEq/L, Ca2+ 3.0 mEq/L, Mg+2 3.0 mEq/L, Cl 105.0 mEq/L, glucose 5.0%(m/v).

Using for questions A-D : HCO3-, Na+, Ca2+, Mg2+,K+, Cl-

A) Which electrolyte concentrations are higher than normal serum values in Michelle's pre-dialysis blood test (see the table)?

B) Which electrolyte concentrations are lower than normal serum values in Michelle's pre-dialysis blood test (see the table)?

C)Which electrolytes need to be increased by dialysis for Michelle's blood serum?

D)Which electrolytes are decreased by dialysis for Michelle's blood serum?

Electrolytes in Blood Plasma and Selected Intravenous Solutions Normal Concentrations of lons (mEq/L) Normal Saline 0.9% NaCl Replacement Solution Lactated Ringer's Solution Blood Plasma Maintenance Solution (extracellular) Maintains electrolytes and fluids Purpose Replaces fluid loss Hydra tion Replaces electrolytes Cations 135-145 3.5-5.5 4.5-5.5 1.5-3.0 154 130 40 140 4. 35 10 Mg2+ Total Anions Acetate 154 137 75 158 47 95-105 154 109 40 103 HCO3 Lactate HPO42 Citrate Total 22-28 28 20 1.8-2.3 15 154 137 75 158

Explanation / Answer

A. The electrolyte concentrations are higher than normal serum values in Michelle's pre-dialysis blood test are

Cl- = High
Na+ - High
Ca2+ - High

B. The electrolyte concentrations are lower than normal serum values in Michelle's pre-dialysis blood test are

K+ - less
Mg2+ - Less

C. The electrolytes need to be increased by dialysis for Michelle's blood serum are K+ and Mg2+ .

D. The electrolytes are decreased by dialysis for Michelle's blood serum are Cl- , Na+ and Ca2+

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