Nxstage prescriptions

[tyefly]

  What is the difference between lactate 40 and 45....what does this do and how are they different....

  also  what is the difference between K1  and K2 soln    what does this do and how are they different....

         they have me on lactate 45  and  K2 soln with pure flow and K1 in the bags........   I would like to know what the difference ..



Edited: Fixed subject line error - okarol/admin

[jbeany]

Oh, shoot - I tossed all the books on this when I turned my NxStage back in.  The K means how much potassium is in the the fluid.  This should be adjusted according to your blood work.  If NxStage, which tends to work better than regular hemo, takes too much potassium out of your bloodstream, the dose can be changed to give you more, or the reverse can be done if the potassium levels are still too high.  If I remember correctly, they didn't make as many options for potassium levels in one mode compared to the other - pureflow versus bags, I mean.  So even if you were on one prescription for pureflow, you might end up with bags that weren't the same, because the different K versions weren't always available in bags.  Don't quote me on that, though - it's been a long time since I had a NxStage.

Having a brain freeze on the lactate, though. ..

[Zog]

I don't know much about playing with potassium concentration, but we have changed lactate.

Lactate is turned into bicarbonate by the liver.  Bicarb is the body's natural acid-base balancer or buffer.  Those incenter types are all bicarb this and bicarb that, well if you do NxStage you will be lactate this and lactate that.  They can't store bicarb in bags of dialysate because it degrades (binds with calcium) so they use lactate.  Some people used acetate long before NxStage to do the same thing and it didn't work as well.

This is my understanding of it.  Please correct me if I'm wrong.

If you run a long treatment they may drop you to Lactate 40 bags or saks from Lactate 45.  This all depends on your bicarb labs.

I sometimes wish they made customized bags to fix your bloodwork, but the theory is that the longer you run the more your blood will be like what's in the dialysate and the dialysate concentrations are supposed to be "perfect".

My wife was low in blood calcium after her parathyroidectomy two weeks ago.  They added calcium to her dialysate (bath) to help bring it up on the hospital machine.  You can't do this with NxStage at home and they wouldn't want you to because you can't do blood labs at home and be responsible for mixing up a special dialysate to fix them.

About a year ago, Bill Peckham posted a link to an audio interview with one of the first men to research making dialysate on his blog.  It was pretty interesting.  Nuclear engineers were involved.

[tyefly]

  thx  guys    I have been trying to find out other places along with here on IHD......  you guys are right  and  I am going to look at my labs and make a recommendation.......AFter all its my body....

[Bill Peckham]

About a year ago, Bill Peckham posted a link to an audio interview with one of the first men to research making dialysate on his blog.  It was pretty interesting.  Nuclear engineers were involved.

Here is a written interview about the early collaborative days in Seattle, and Les Babb who is still around. They had a nuclear reactor on the UW's campus, which today most people are surprised to find out and it was the guys who ran it who figured out how to mix and deliver dialysate.
http://ieeeghn.com/wiki/index.php/Oral-History:Albert_%22Les%22_Babb#Hemodialysis.3B_central_system_for_multi-patient_dialysis
The single patient dialysis machine part is very interesting - scroll down. His dialysate proportioning system is basically the one being used today. However, like the Scribner shunt it was just given to the world rather than patented.