Intradialytic hypercapnic respiratory failure managed by noninvasive assisted ventilation

David Tovbin, Dov Heimer, Abdallah Mashal, Pinchas Degtyar, Lone Solling Avnon

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5 Scopus citations


We report a hemodialysis patient with acute hypercapnic respiratory failure managed on noninvasive intermittent positive pressure ventilation and progressive metabolic acidosis. Dialysate bicarbonate concentration of 25 mEq/l was associated with exacerbation of metabolic acidosis, while higher dialysate bicarbonate concentration of 30 mEq/l induced a dangerous increase in PCO2 level. Excessive bicarbonate buffering and CO2 production induced by severe metabolic acidosis, malnourishment and tissue hypoxia, could explain inadequate correction of metabolic acidosis and worsening of hypercapnia in this patient. Our findings suggest the need for close monitoring of blood gases and cautious modulation of dialysate bicarbonate concentration in the presence of progressive metabolic acidosis in hypercapnic hemodialysis patients.

Original languageEnglish
Pages (from-to)383-385
Number of pages3
JournalAmerican Journal of Nephrology
Issue number5
StatePublished - 1 Dec 2001


  • Bicarbonate buffering
  • Dialysate
  • Hypercapnia
  • Obesity
  • Respiratory failure


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