What Is Peritoneal Fluid?

Peritoneal dialysis uses the peritoneum as a semi-permeable membrane. The peritoneal capillaries and the dialysate exchange water and solutes. The electrolytes and small molecular substances move from the higher concentration side to the lower side (dispersion). Move from the low osmotic side to the high osmotic side (osmosis). Increasing the concentration of dialysate can achieve the purpose of removing water from the body. The gradual difference in solute concentration can make the urinary substances in the blood cleared from the dialysate, and maintain the electrolyte and acid-base balance, replacing some functions of the kidney.

Peritoneal dialysate

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Peritoneal dialysis uses the peritoneum as a semi-permeable membrane. The peritoneal capillaries and the dialysate exchange water and solutes. The electrolytes and small molecular substances move from the higher concentration side to the lower side (dispersion). Move from the low osmotic side to the high osmotic side (osmosis). Increasing the concentration of dialysate can achieve the purpose of removing water from the body. The gradual difference in solute concentration can make the urinary substances in the blood clear from the dialysate, and maintain the electrolyte and acid-base balance, replacing some functions of the kidney.

Chinese name

Peritoneal dialysate

Foreign name

Peritoneal Dialysis Solution

common name

: Peritoneal dialysate (lactate)

Purpose

Increasing the concentration of dialysate can remove water from the body

Common name: peritoneal dialysate (lactate)

Previous name:

Product name:

English name: Peritoneal Dialysis Solution

Phonetic script (Hanyu Pinyin): Fumotouxi Ye

This product is a compound preparation, the components contained in its different specifications are shown in the table below:

Glucose content /%

1.5

2.5

4.25

Per 1000ml

Glucose / g

15

25

42.5

Sodium chloride / g

5.67

5.67

5.67

Calcium chloride / g

0.257

0.257

0.257

Magnesium chloride / g

0.152

0.152

0.152

Sodium lactate / g

5.0

5.0

5.0

This product is a clear, colorless liquid.

Basic principles of peritoneal dialysate formulation:

(1) The dialysate water must be strictly sterile and endotoxin-free.

(2) The electrolyte concentration of dialysate is similar to that of normal plasma, and can be adjusted according to clinical conditions.

The sodium ion concentration is 132mmol / L, which is slightly lower than the normal plasma concentration, which is helpful for correcting sodium retention when renal failure;

The chloride ion concentration is 103mmol / L;

Calcium ion concentration is 1.25 1.75mmol / L;

The concentration of magnesium ion is 0.25 0.75mmol / L.

The dialysate generally does not contain potassium ions, which is beneficial to remove excess potassium ions from the body and maintain normal potassium levels. However, when hypokalemia occurs, potassium salts can be temporarily added to the dialysate, and 10% per liter of peritoneal dialysate. Potassium chloride solution 3ml, its potassium ion concentration is nearly 4mmol / L.

(3) The concentration of dialysate is generally slightly higher than the osmotic concentration of plasma, which is beneficial to the removal of water from the body. Therefore, the osmotic concentration of dialysate can be appropriately increased according to the degree of water retention in the body. At present, glucose is mostly used to maintain the osmotic concentration. Generally, 1.5% glucose peritoneal dialysate is used as the basis, and its osmotic concentration is 346mOsm / L. If it is necessary to increase the body water clearance, 2.5% glucose concentration can be used. Each 1% increase in glucose concentration per liter of dialysate can increase the osmotic concentration by 55mOsm / L. The maximum glucose concentration in the existing peritoneal dialysate is 4.25%, and the highest osmotic concentration is 490mOsm / L (generally limited to once a day or not used), unless severe edema or acute pulmonary edema try to avoid using high-concentration glucose dialysate to avoid excessive Dehydration, causing severe hyperglycemia, and hyperglycemic stimulation of the peritoneum cause the peritoneum to lose ultrafiltration.

(4) The pH value of the peritoneal dialysate is 5.0 to 5.8. At present, lactate is used as the base. After entering the body, it is metabolized into bicarbonate ion by the liver.

Pharmacokinetics

(1) Acute renal failure.

(2) Chronic renal failure.

(3) Acute drug or poisoning.

(4) Intractable heart failure.

(5) Refractory edema.

(6) Electrolyte disorders and acid-base balance disorders.

(1) For patients with acute and chronic renal failure with water retention, use intermittent peritoneal dialysis for 2L each time, leave for 1 to 2 hours, and exchange 4 to 6 times daily. Anhydrous retention, continuous ambulatory peritoneal dialysis (CAPD), usually 4 times a day, 2L each time, 4 to 5 hours at a time during the day, 9 to 12 hours at night, to increase middle molecular uremia Toxin removal. The daily daily dialysate volume is 8L.

(2) For the treatment of acute left heart failure, use 2.5% or 4.25% glucose dialysate 2L as appropriate; the latter can be dehydrated for 300 to 500ml for 30 minutes, and the former can be dehydrated for 100 to 300ml for 1 hour.

Common adverse reactions to peritoneal dialysate are:

(1) Dehydration.

(2) Hypokalemia.

(3) Hyperglycemia.

(4) Hyponatremia and hypochloremia, metabolic alkalosis.

(5) Chemical peritonitis.

(1) Extensive intestinal adhesions and intestinal obstruction.

(2) Severe respiratory insufficiency.

(3) Extensive infection of abdominal skin.

(4) Within 3 days of abdominal surgery, and there is surgical drainage in the abdomen.

(5) Vascular disorders in the abdominal cavity.

(6) Huge tumors and polycystic kidney in the abdominal cavity.

(7) High catabolism.

(8) Those who cannot take enough protein and calories for a long time.

(9) Hernia is not repaired.

(10) Uncooperative or mentally ill patients.

(1) Peritoneal dialysis fluid is poured or discharged multiple times a day, and the aseptic operation should be strictly performed in accordance with the peritoneal dialysis routine.

(2) Pay attention to water, electrolyte and acid-base balance.

(3) During peritoneal dialysis, dialysate containing 1.5% to 2.5% glucose is mainly used. Those with poor dehydration by ultrafiltration can only use 4.25% intermittently. Diabetics should closely observe blood glucose levels.

(4) The remaining liquid medicine shall not be reused.

(5) If this product is used for a long time, it should avoid causing peritoneal ultrafiltration, and potassium should be prescribed by your doctor.

(6) This product cannot be used for intravenous injection.

(7) If hepatic insufficiency, lactate-containing peritoneal dialysate should not be used.

(8) As far as possible, do not use high-permeability fluids to avoid hyperglycemia and excessive protein loss.

(9) It should be heated to about 37 ° C before use; and the dialysate should be checked for leaks, particulate matter, floc, discoloration, turbidity, etc.

(10) Under normal circumstances, do not add medicine to the peritoneal dialysis solution at will; in special circumstances, dosing treatment can be done according to changes in the condition, but care should be taken to avoid irritating the peritoneum.

[Medication for pregnant and lactating women]

Peritoneal dialysis is contraindicated in late pregnancy.

[Child medication]

The amount of each exchange is generally 50ml / kg body weight.

[Medication for elderly patients]

Blood glucose should be closely observed; attention should be paid to whether cardiovascular function is suitable for peritoneal dialysis.

medicine interactions

[Drug overdose]

specification

(1) 1000ml (2) 2000ml

Storage

Protected from light and sealed.

The main components of dialysate are sodium, chlorine, calcium, magnesium, sodium lactate and glucose. The sodium concentration is 132 mmol / L; the chlorine concentration is similar to the plasma chlorine; the magnesium concentration is generally 0.275 mmol / L, which is lower than the plasma magnesium concentration (0.55-0.7 mmol / L); Oral dialysis patients with high concentrations and good diets generally do not need oral calcium; dialysate does not contain potassium and bicarbonate. Multi-purpose sodium lactate for dialysate buffer alkali is commonly used at a concentration of 40 mmol / L. Glucose is available in three concentrations: 1.5%, 2.5%, and 4.25%. The higher the sugar concentration in the dialysate, the greater the permeability.

The peritoneal dialysis solution was initially packaged in a single bag. Later, the "O-set" system and the "dual double-bag" system gradually appeared. The continuous improvement of the package has brought about a significant decrease in the incidence of peritonitis, which has significantly improved the survival rate of peritoneal dialysis patients. Prolonged, the number of peritoneal dialysis patients is increasing year by year. For more than ten years, the "dual-connected double-bag" type of peritoneal dialysis has become a clinically preferred peritoneal dialysis fluid packaging system due to its advantages such as easy operation by medical staff and patients, safe and reliable performance, and favorable for reducing the risk of infection.

On the other hand, the initial production of peritoneal dialysate was packaged in soft polyvinyl chloride (PVC) bags. PVC contains plasticizers such as DEHP. Animal tests have found that long-term intake of DEHP in large quantities can cause endocrine disruption, cause reproductive and developmental disorders, and can induce liver cancer in animals. DEHP will be precipitated into the peritoneal dialysate. According to the report of "Safety Evaluation of DEHP Removal from PVC Medical Devices" issued by the US FDA, patients with peritoneal dialysis using PVC packaged peritoneal dialysate should be taken daily by peritoneal dialysate. Injected DEHP can reach tens of milligrams, and the World Health Organization (WHO), the United States and the European Union believe that each person ingests DEHP of 1.5mg, 2.4mg and 3.0mg per day is safe. In order to improve the safety of peritoneal dialysis and reduce the long-term effects of toxic substances on the patient's body, non-PVC packaging materials should be developed.