dialysate solution

 Q: Which of the following electrolyte is NOT part of dialysate solution? 

 A) sodium 

B) potassium 

C) calcium 

D) phosphate

E) chloride

Answer: D

Dialysate solution universally contains six electrolytes in which sodium, calcium, magnesium, and chloride are present as equivalent in extracellular fluid. Potassium and bicarbonate are used as buffers. Glucose is the seventh component which is almost always included, Nephrologist may decide to hold it in case of severe hyperglycemia though its inclusion is recommended despite hyperglycemia to avoid hypoglycemia which can be detrimental without warning. 

Dialysate solution is an isotonic solution with an osmolality of 300 ± 20 milliosmoles per liter (mOsm/L). The goal is to keep the osmolality of dialysate close to plasma osmolality to avoid red blood cell hemolysis and/or crenation. 

Hyperphosphatemia is common in patients with renal failure and can be a marker of disease severity. Although hypophosphatemia is common in patients who undergo Continuous Renal Replacement Therapy (CRRT), it is usually corrected by supplementation. 

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References: 

1. Desai N. (2015). Basics of base in hemodialysis solution: Dialysate buffer production, delivery and decontamination. Indian journal of nephrology, 25(4), 189–193. https://doi.org/10.4103/0971-4065.147369 

2. Song YH, Seo EH, Yoo YS, Jo YI. Phosphate supplementation for hypophosphatemia during continuous renal replacement therapy in adults. Ren Fail. 2019;41(1):72-79. doi:10.1080/0886022X.2018.1561374 

3.  Jung, S. Y., et. al (2018). Phosphate is a potential biomarker of disease severity and predicts adverse outcomes in acute kidney injury patients undergoing continuous renal replacement therapy. PloS one, 13(2), e0191290. https://doi.org/10.1371/journal.pone.0191290