Figure 28

During a typical dialysis session approximately 80 to 100 mEq/L of potassium is removed from the body. A, Potassium (K) flux from the extracellular space across the dialysis membrane exceeds the flux of potassium out of the intracellular space. B, The movement of potassium between the intra- and extracellular spaces is controlled by a number of factors that can be modified during the dialysis procedure [17,18]. As compared with a glucose-free dialysate, a bath that contains glucose is associated with less potassium removal [19]. The presence of glucose in the dialysate stimulates insulin release, which in turn has the effect of shifting potassium into the intracellular space, where it becomes less available for removal by dialysis. Dialysis in patients who are acidotic is also associated with less potassium removal since potassium is shifted into cells as the serum bicarbonate concentration rises. Finally, patients treated with inhaled p stimulants, as for treatment of hyperkalemia, will have less potassium removed during dialysis since p stimulation causes a shift of potassium into the cell [20].

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