Potassium Question

[Rerun]

Tonight the pumps in back broke down.  So they were running in sincranization only pulling fluid.  The 2k was broke but the 3k was running.  So, I said just put me on 3k and XXXXX (the young tech) was trying to tell me that 3k would ADD potassium to my blood.  WHAT?  He said that 2k kept your blood the same and 3k added potassium to your blood and 1k took it down. 

You can't be adding anything to your blood through the bath!  It is not sterile. 

Also, what does the machine warm.  Your dialysate, or the water or both.  I was getting cold and the nurse told me that since the dialysate was off and that is what the machine warms up.  I said is the water still on.  She said no.  I said SOMETHING has to be bathing the fibers.  Oh I guess the water is on but the machine doesn't warm that up.  WHAT??  That water in those places is COLD.

Any feedback would be helpful.           

[circleNthedrain]

Hey Rerun, I don't have the answer about what is heated by the machine, but I bet someone will. (I think it is the dialysate).  I know I was on a 2K bath for awhile, until my K got too high.  I've been on 1K bath and now my K is normal, with no dietary changes.  Hope this helps a little.

[boxman55]

The only thing that keeps me warm is my blanket. I run on a 1K bath also. It allows me to eat french frys...Boxman

[monrein]

Electrolytes, things like potassium and sodium, are removed from the blood via the dialysate through the process of diffusion.  These small particles move through the membrane of the dialyzer and are washed away.  If the concentration of these particles is higher on the dialysate side they will also move the other way and into the blood since through diffusion the two sides constantly seek to be equal.

Here is Wikipedia's explanation.

Semipermeable membrane
The principle of hemodialysis is the same as other methods of dialysis; it involves diffusion of solutes across a semipermeable membrane. Hemodialysis utilizes counter current flow, where the dialysate is flowing in the opposite direction to blood flow in the extracorporeal circuit. Counter-current flow maintains the concentration gradient across the membrane at a maximum and increases the efficiency of the dialysis.
Fluid removal (ultrafiltration) is achieved by altering the hydrostatic pressure of the dialysate compartment, causing free water and some dissolved solutes to move across the membrane along a created pressure gradient.
The dialysis solution that is used is a sterilized solution of mineral ions. Urea and other waste products, and also, potassium and phosphate, diffuse into the dialysis solution. However, concentrations of sodium and chloride are similar to those of normal plasma to prevent loss. Bicarbonate is added in a higher concentration than plasma to correct blood acidity. A small amount of glucose is also commonly used.
Note that this is a different process to the related technique of hemofiltration.

[peleroja]

In PD we warm up the dialysate, so it seems logical to be the dialysate.

[flip]

Monrein is correct. The acid bath contains potassium, sodium and magnesium. The potassium level in the blood will diffuse toward the level in the dialysate, so a 3K will remove less potassium than a 1 or 2K.

[Rerun]

I always have a high potassium.  Usually 5.5 to 6.  My doc won't put me on 1k.  Says it is against policy because some study showed more heart attacks with 1k.  But my potassium is always high. The 2k wouldn't work.  Wouldn't it be better to run me on 3K than not run me at all??  For a weekend??  They were just pulling fluid?

I realize that 3K pulls less.  But not pulling anything is stupid!

[Rerun]

I called the center to see if the 2k pump was fixed.  They said yes.  I asked what the early shift did. 

They just ran everybody on a 3k.  OH Really!  How brilliant is that!

                                                               

[Wallyz]

You were correct rerun, that a 3k bath would have been better than nothing.  Write a letter.  That's really poor care.