Haemodialysis solutions

Gram-negative baeteria eontain lipopolysaeeharides (endotoxins) in their outer membranes that ean remain in an active condition in products even after eell death and some ean survive moist heat sterilizatioa Although inactive by the oral route, endotoxins can induce aeute and often fatal febrile shock if they enter the bloodstream via contamirrated irrfirsion fluids, even in nanogram quantities, or via diffusion aeross membranes ftxm eontarrrinated haemodialysis solutions. 

Haemodialysis is the process of circulating the patient s blood through a machine via tubing composed of a semi-permeable material such that waste products permeate into the dialysing fluid and the blood then returns to the patient Haemodialysis solutions need not be sterile but must be flee flxm heavy bacterial contamination. 

Clear or drop impact resistant containers, boxes, hot filled bottles, dessert pots, horticultural pots, integrated hinge boxes, bottles and other cans up to several litres, caps and closures for beverage and cosmetic applications, medical disposable trays, containers for irrigation, parenteral, haemodialysis solutions. .. 

Medical disposable trays, containers for irrigation, parenteral, haemodialysis solutions... 

The calcium (Ca) and magnesium (Mg) in a haemodialysis solution were analysed... 

From the data given above calculate the concentration of mg in the haemodialysis solution in mmoles/1. 

AAS is used in a number of limit tests for metallic impurities, e.g. magnesium and strontium in calcium acetate palladium in carbenicillin sodium and lead in bismuth subgallate. It is also used to assay metals in a number of other preparations zinc in zinc insulin suspension and tetracosactrin zinc injection copper and iron in ascorbic acid zinc in acetylcysteine lead in bismuthsubcarbonate silver in cisplatinum lead in oxyprenolol aluminium in albumin solution and calcium, magnesium, mercury and zinc in water used for diluting haemodialysis solutions. 

Fluorescence measurements are useful in limit tests where the trace impurity is fluorescent or can be rendered fluorescent by chemical modification. An example is the determination of aluminium in water for use in haemodialysis solutions by formation of its salt with 8-hydroxyquinolone (Fig. 7.5) followed by quantifieation of the complex using fluorescenee speetrophotometry. The excitation wavelength is set at 392 nm and the emission is measured at 518 nm. This type of fluorescent complex can be used to determine low levels of a number of metal ions. 

Irrigations and haemodialysis solutions are mostly administered by a physician or a specialised nurse. 

Haemodialysis usually takes about 4-7 h and the dialysing solutions are changed periodically. Ask in your hospital about the exact procedures used for dialysis, usually organized by the renal unit. You also might ask what stringent safety and health risk precautions the workers must undertake when working in the unit. 

Haemofiltration This procedure turned out to be of more value than haemodialysis. No dialysate fluid is required. Instead, a solution containing buffered bicarbonate is used to replace the ultrafiltrate. In fulminant hepatic failure, continuous venovenous haemofiltration is recommended because of its advantages for the circulation and metabolism. Heparin or prostacyclin can be used as anticoagulants (C.A.E. Gimson et al., 1980). 

KooistraMP. Frequent prolonged home haemodialysis three old concepts, one modem solution. Nephrol Dial Transplant 2003 18 16-19. 

In an investigation of the movement of fluoride in haemodialysis it has been shown [175] that when the dialysate is prepared with fluoridated water, fluoride moves from the dialysate to blood at a rate comparable with the movement of solutes in the opposite direction. It is suggested that the resulting serum fluoride values are likely to result in altered bone formation [175]. 

A special form of irrigations are solutions for dialysis that are necessary for the different types of dialysis such as haemodialysis, haemo(dia)filtration and peritoneal dialysis. 

Peritoneal dialysis gives the patient more freedom than haemodialysis, but requires a suitable space at home and appropriate skills. The patient may gain weight from these glucose containing solutions. 

Concentrates (concentrated solutions) for haemodialysis are diluted with water in the dialysis machine prior to use. 

The Ph. Eur. requires solutions for haemodialysis, after dilution, to contain not more than 0.5 lU/mL. Solutions for haemo(dia)filtration and peritoneal dialysis have to be sterile and should not contain more than 0.05 lU/mL bacterial endotoxins according to the present Ph. Eur. requirements (Ph. Eur. 8.0). During a haemo(dia)filtration treatment a large volume of the solution is administered parenterally to the patient (about 60 L per dialysis session). The more stringent requirement for bacterial endotoxins in solutions for haemo(dia)filtration compared to that for solutions for haemodialysis is due to the large volume of solution administered with the first technique. 

It is obvious that for the preparation of solutions for haemodialysis or haemo(dia)filtration special requirements are needed to control the quality of water. 

According to Ph. Eur. Preparations for irrigation are supplied in single-dose containers. , for all sterile irrigations and dialysis solutions, with the exception of the concentrated solutions for haemodialysis, the container and the closure... 

The diluted solutions for haemodialysis and haemodia-filtration that are prepared from the concentrate do not have a shelf life, because they are prepared in the dialysis machine immediately before use. 

Mineral and metal metabolism An 18-year-old woman, with a history of abdominal surgery for type B intestinal neuronal dysplasia, developed diffuse muscle weakness, carpopedal spasm, tetany and confusion 6 h after intake of the last dose of an oral phosphate solution (Fleet Phosphosoda ) prescribed as bowel preparation for colonoscopy. These symptoms were associated with elevations in serum creatinine, potassium and phosphorous levels and decreases in glomerular filtration rate, sodium and calcium levels. Following repeated sessions of haemodialysis, both calcium and phosphorous serum concentrations returned to normal levels after a day. In contrast, the glomerular filtration rate started to return to baseline after 4 days [74 ]. 

Catheter-related bacteraemia (CRB) and catheter dysfxmction are major sources of morbidity and mortality when central venous catheters (CVCs) are used as long-term vascular access devices in haemodialysis patients. Attempts have been made to minimise these complications by the prophylactic use of catheter locking solutions. The current study aims to describe the recent advances in the field of lock solutions and discusses the benefits and risks associated with the routine use of antimicrobial and/or antithrombotic lock solutions [ll J. These solutions may improve patency and CRB, but at the same time, these may be cost-prohibitive. 

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