Pearl R G, Rosenthal M H
Am J Med. 1985 Sep;79(3):391-3. doi: 10.1016/0002-9343(85)90320-1.
Progressive metabolic alkalosis developed in two patients undergoing daily plasmapheresis for diffuse intrapulmonary hemorrhage associated with glomerulonephritis (Goodpasture's-like syndrome). The metabolic alkalosis promptly resolved when the plasmapheresis procedure was altered so that 3 percent albumin and cryoprecipitate rather than fresh frozen plasma were used as replacement for the removed patient plasma. The development of metabolic alkalosis during plasmapheresis can be explained by the large sodium citrate load given during the procedure. Severe metabolic alkalosis may develop in patients with decreased renal function when they are treated with plasmapheresis. The metabolic alkalosis can be prevented by appropriate modifications in the plasmapheresis protocol.
两名因肾小球肾炎（类 Goodpasture 综合征）伴弥漫性肺内出血而接受每日血浆置换治疗的患者发生了进行性代谢性碱中毒。当改变血浆置换程序，使用 3%白蛋白和冷沉淀而非新鲜冰冻血浆来替代去除的患者血浆时，代谢性碱中毒迅速得到缓解。血浆置换过程中代谢性碱中毒的发生可通过该过程中给予大量柠檬酸钠来解释。肾功能减退的患者在接受血浆置换治疗时可能会发生严重的代谢性碱中毒。通过对血浆置换方案进行适当调整可预防代谢性碱中毒。
