• Hyponatremia can occur when sodium concentration is high and the conductivity monitors of the dialysis machine are not functioning or the alarms are not set properly
  • Dialysate conductivity can be incorrectly sensed as low by the coated conductivity cells (that gets coated by granules from less soluble batch of sodium bicarbonate powder)1
    • At the start of dialysis if an error is made when connecting concentrate containers
    • During dialysis if containers run dry and conductivity monitor fail


  • Dialysis can be resumed with dialysate sodium 2 mEq/L lower than plasma sodium concentration while infusing isotonic saline. Use of dialysate sodium 3-5 mEq/L lower than plasma sodium might increase the risk of disequilibrium syndrome.


  • Frequent check of conductivity monitors which can get coated with bicarbonate granules2 and can cause falsely low readings


  1. Williams DJ, Jugurnauth J, Harding K, Woolfson RG, Mansell MA. Acute hypernatraemia during bicarbonate-buffered haemodialysis. Nephrol Dial Transplant 9:1170-1173, 1994
  2. Sterns RH, Silver SM. Hemodialysis in hyponatremia: Is there a risk? Semin Dial 3:3-4, 1990