Truniger B, Colombi A
Schweiz Med Wochenschr. 1976 Aug 14;106(33):1102-9.
Observation of a patient who developed serious hypernatremia during peritoneal dialysis with a dialysis fluid containing 135 mval Na+/1 prompted investigation of net water, sodium, potassium and chloride transport during 45 peritoneal fluid exchanges with standard dialysis solutions containing 1.5 and 4.5 g% glucose. With both solutions and an equilibration time of 0 min, net ultrafiltration was observed (89 ml and 230 ml per exchange respectively). In both groups the calculated sodium concentration of the ultrafiltrate was considerably lower than plasma sodium concentrations (27.0 mval/1 and 36.9 mval/1 respectively, resulting in a new sieving coefficient of 0.20 and 0.27 respectively. Therefore, the free water deficit resulting from peritoneal ultrafiltration is directly responsible for the hypernatremia observed during peritoneal dislysis. While the potassium and chloride transport observed in these studies can be explained by diffusion processes along a given concentration gradient, sodium transport and sodium concentrations raise the question of more complex mechanisms. The data are discussed with reference to the relative significance of diffusion processes versus bulk flow and solvent drag.
观察到一名患者在使用含135 mval Na⁺/L的透析液进行腹膜透析期间发生严重高钠血症，促使对使用含1.5%和4.5%葡萄糖的标准透析液进行45次腹膜液交换期间的净水分、钠、钾和氯转运进行研究。使用这两种溶液且平衡时间为0分钟时，均观察到净超滤（每次交换分别为89毫升和230毫升）。在两组中，计算出的超滤液钠浓度均显著低于血浆钠浓度（分别为27.0 mval/L和36.9 mval/L，导致新的筛系数分别为0.20和0.27）。因此，腹膜超滤导致的自由水缺乏是腹膜透析期间观察到的高钠血症的直接原因。虽然这些研究中观察到的钾和氯转运可以用沿给定浓度梯度的扩散过程来解释，但钠转运和钠浓度提出了更复杂机制的问题。结合扩散过程与整体流动和溶剂拖曳的相对重要性对数据进行了讨论。
