Prevention of carbon dioxide (CO<sub>2</sub>) narcosis during hemodialysis in elderly hypercapnic patients by lowering bicarbonate (HCO<sub>3</sub><sup>−</sup>) concentration of dialysate

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  • 透析液重炭酸濃度の低減により透析中のCO<sub>2</sub>ナルコーシスを防げた高齢の慢性高CO<sub>2</sub>血症の2例
  • 症例報告 透析液重炭酸濃度の低減により透析中のCO₂ナルコーシスを防げた高齢の慢性高CO₂血症の2例
  • ショウレイ ホウコク トウセキエキジュウ タンサン ノウド ノ テイゲン ニ ヨリ トウセキ チュウ ノ CO ₂ ナルコーシス オ フセゲタ コウレイ ノ マンセイ コウCO ₂ ケツショウ ノ 2レイ
  • Prevention of carbon dioxide (CO<sub>2</sub>) narcosis during hemodialysis in elderly hypercapnic patients by lowering bicarbonate (HCO<sub>3</sub><sup>&minus;</sup>) concentration of dialysate

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Abstract

Carbon dioxide (CO2) narcosis developed in chronically hypercapnic patients during hemodialysis using dialysate with a bicarbonate (HCO3−) concentration of 25-30 mEq/L. The elderly hemodialysis patients had presented with hypoventilation because of atrophy in the respiratory muscles due to malnutrition. The hypercapnic respiratory failure during hemodialysis was prevented by lowering the HCO3− concentration to 22 mEq/L. During hemodialysis, the supply of HCO3− from dialysate to the blood desensitizes respiratory chemoreceptors for pulmonary ventilation. The elevation of blood HCO3− concentration also raises PaCO2 by the reaction between HCO3− and H+. Dialysate HCO3− concentration should be modified for patients with ventilatory failure to prevent excessive CO2 retention.

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