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Basic knowledge of hemodialysis

Basic knowledge of hemodialysis

Dialysis is a process from one side of the semipermeable membrane solute through the membrane to the other side, any natural or artificial (such as peritoneal) semipermeable membrane, the membrane containing the solute as long as a certain...


Dialysis is a process from one side of the semipermeable membrane solute through the membrane to the other side, any natural or artificial (such as peritoneal) semipermeable membrane, the membrane containing the solute as long as a certain size through the aperture, then these can solute diffusion and convection from the mobile side of the membrane to the other side of the membrane. The "poison" in the human body, including metabolites, drugs, exogenous toxins, as long as the appropriate amount of atomic or molecular weight, it can be eliminated by dialysis in vitro. Its basic principle is diffusion and convection. The dispersion is on both sides of each containing liquid membrane solute concentration gradient and it formed different osmotic concentration, high concentration of solute from the side through a semipermeable membrane to the mobile side of low concentration. Convection, also known as ultrafiltration, refers to the process of transmembrane transport of solute and solvent due to the difference of hydrostatic pressure and osmotic pressure on both sides of the membrane.

What are the indications of hemodialysis?

Hemodialysis is an effective method for the treatment of acute and chronic renal failure and some acute drug poisoning:
(1) acute renal failure: anuria or oliguria for more than 2 days, accompanied by hypertension, water intoxication, pulmonary edema, cerebral edema of; the blood urea nitrogen more than 35.7 mmol / L (100 mg / dl) or >10.7 mmol / L increased daily (30 mg / dl); the serum creatinine more than 530.4 mol / L; the hyperkalemia, hypokalemia is greater than 6.5 mmol / L; the metabolic acidosis, carbon dioxide combining power less than 13 mmol / L, drug treatment is invalid.
(2) chronic renal failure: the serum creatinine greater than 884 micromoles / liter (10 mg / dl); the blood urea nitrogen of 35.7 mmol / L (100 mg / dl); serum creatinine clearance less than 5 ml / min.. Accompanied by the following situations: heart failure or uremic pericarditis; hyperphosphatemia, difficult to control, clinical and radiographic findings of soft tissue calcification; the severe electrolyte disorder or metabolic acidosis; the apparent retention of water and sodium, such as high swelling and higher blood pressure; the severe symptoms of uremia, such as nausea, vomiting, fatigue etc..
(3) acute drug or poison poisoning: poison can be precipitated by dialysis membrane, should be within 8-16 hours after poisoning.
(4): the other emergency treatment of refractory congestive heart failure and acute pulmonary edema; the hepatobiliary diseases, such as preparation of liver failure, ascites, refractory cirrhosis of patients with obstructive jaundice before operation; the water electrolyte disorder caused by various reasons, such as hyponatremia and hyperkalemia.
What drugs or poisons can be passed through the dialysis membrane?
Through the dialysis membrane mainly drugs and poisons: sedative hypnotic drugs, barbiturates, meprobamate, methaqualone, diazepam, chlordiazepoxide, chloral hydrate and wintermin; the analgesic antipyretic drugs: aspirin, phenacetin and paracetamol, tricyclic antidepressants; Yu: a drug for its forest, equal consideration; the cardiovascular drugs: digitalis, quinidine, procainamide, sodium nitroprusside, methyldopa, diazoxide, phenytoin two; the anticancer drug 5-: cyclophosphamide, fluorouracil; 6: toxic organic phosphorus, carbon tetrachloride, trichloroethylene, arsenic and mercury 7; nephrotoxicity and ototoxicity of antibacterial drugs: streptomycin, kanamycin, neomycin, vancomycin, tobramycin, amikacin, gentamycin, polymyxin etc..

What are the contraindications of hemodialysis?

The severe anemia; the severe hypotension or shock; serious cardiac complications, such as obvious cardiac hypertrophy and cardiac dysfunction, serious arrhythmia, hypertension or cerebrovascular disease; the end-stage uremia and irreversible complications; the uncontrolled diabetes; the serious infection; and at the same time for cancer and other malignant diseases the big; 3 days after operation; elderly high-risk patients, 9 psychosis, uncooperative infants.
Because there is no effective treatment for renal failure, hemodialysis patients often is urgent treatment, basic clinical measures are also available, and the dialysis device improvement and popularization of dialysis technology and conditions continue to improve, in the relaxed dialysis taboo.
 

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