Metabolic Acidosis

  • Can occur accidentally as a consequence of dialysate fluid containing improper ratios of acid and base concentrates in the form of acetate or bicarbonate1,2.
  • Can also develop as a result of the accidental use of an acidic concentrate instead of acetate or bicarbonate and due to computer software malfunction of the machine
  • Severe metabolic acidosis has been reported during first 2 hours of HD using sorbent regenerative hemodialysis in mechanically ventilated patients3
  • Treatment consists of intravenous administration of bicarbonate and dialysis with bicarbonate dialysate of a correct concentration (38-40 mEq/L)
  • The mainstay of prevention is to fit all HD machines with a pH meter and alarms that will prevent the extreme acid load, which may be caused by an inappropriately prepared bicarbonate dialysate. Conductivity checks are vital.


  1. Hartmann A, Reisaeter A, Holdaas H, Rolfsen B, Fauchald P. Accidental metabolic acidosis during hemodialysis. Artif Organs 18:214-217, 1994
  2. Gainza FJ, Zarraga S, Minguela I, Lampreabe I. Accidental substitution of acid concentrate for acetate in dialysis fluid concentrate: A cause of severe metabolic acidosis. Nephron 69:480-482, 1995
  3. Reyes A, Turchetto E, Bernis C, Cereijo E. Acid-base derangements during sorbent regenerative hemodialysis in mechanically ventilated patients. Crit Care Med 19:554-559, 1991