Hemodialysis is a life-saving medical modality that cleanses the blood using an artificial kidney, called a dialyzer. Hemodialysis uses contact between the patient's blood and the semipermeable membrane of the extracorporeal dialyzer to remove compounds such as blood urea nitrogen, creatinine, electrolytes, minerals, anions, cations, certain drugs and toxins, and excess fluid from the bloodstream. The extracorporeal dialyzer distinguishes hemodialysis from peritoneal dialysis, which uses a patient's peritoneum as the dialysis membrane. There are 2 main types of hemodialysis: intermittent hemodialysis and continuous renal replacement therapy. This article focuses on intermittent hemodialysis for acute and chronic kidney injury.
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Hyperchloremic metabolic acidosis is a known complication following ileal conduit urinary diversion, often arising from urinary reabsorption in the ileum, which leads to chloride retention and bicarbonate loss and, though often asymptomatic, can produce clinically significant symptoms, particularly in patients with underlying renal impairment. A 75-year-old woman with a history of bladder cancer underwent cystectomy with ileal conduit diversion and presented on postoperative day 47 with anorexia, hypotension, and weight loss; laboratory findings revealed hyperchloremic metabolic acidosis with elevated serum chloride. The patient's acidosis gradually improved with sodium bicarbonate and Ringer's solution, stabilizing her blood pressure, creatinine, and acid-base balance, and she was discharged with outpatient follow-up.
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[Translated article] National survey and consensus document on dosing strategies for beta-lactam antibiotics against multidrug-resistant gram-negative bacilli (MDR-GNB) in critically ill patients undergoing extracorporeal life-support techniques: The DOSEBL study protocol.
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Servicio de Farmacia, Hospital del Mar - Parc de Salut Mar, Barcelona, Spain; Grupo de investigación en Patología Infecciosa y Antimicrobianos (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
Introduction: Infections caused by multidrug-resistant gram-negative bacilli (MDR-GNB) in critically ill patients present a challenge for timely and appropriate antibiotic treatment. This is particularly important in patients undergoing extracorporeal life-support techniques such as renal replacement therapy and extracorporeal membrane oxygenation. These techniques can introduce additional pharmacokinetic alterations, potentially leading to suboptimal exposure to antibiotics.
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