Neilan B A, Ehlers S M, Kolpin C F, Eaton J W
Clin Nephrol. 1978 Sep;10(3):105-8.
Chloramines, compounds made up of chlorine and ammonia, when present in tap water used for dialysis cause methemoglobinemia and hemolysis. Ascorbic acid addition has been reported to effectively neutralize chloramines in vitro and in patients dialyzed with the single batch dialysis delivery system. We extended these observations to patients dialyzed with the proportioning dialysis delivery system where exposure time of ascorbic acid to chloramines is shorter. This may be important since we found that the half time of the reaction between ascorbic acid and chloramines is 4 minutes. Red cell oxidant sensitivity in 15 patients was assessed by incubating red cells with ascorbate-cyanide and measuring methemoglobin which averaged 2.17 +/- 0.42 g/100 ml (SEM) before dialysis and 2.87 +/- 0.52 g/100 ml after dialysis (NS). Reduced glutathione (GSH) levels were also measured as an index of red cell oxidant damage. GSH decreased from a mean of 7.40 +/- 0.59 micromoles/g Hb before dialysis to 6.98 +/- 0.52 micronmoles/g Hb after dialysis (P less than 0.01). In 2 patients there was no change in 51Cr red cell survival when dialyzed on either the proportioning system or other chloramine free systems. We conclude that addition of ascorbic acid to neutralize chloramines in tap water is also effective when using the proportioning dialysis delivery system.
氯胺是由氯和氨组成的化合物，当存在于用于透析的自来水中时会导致高铁血红蛋白血症和溶血。据报道，添加抗坏血酸可在体外以及在使用单批透析输送系统进行透析的患者中有效中和氯胺。我们将这些观察结果扩展到使用比例透析输送系统进行透析的患者，在该系统中抗坏血酸与氯胺的接触时间较短。这可能很重要，因为我们发现抗坏血酸与氯胺之间反应的半衰期为4分钟。通过将红细胞与抗坏血酸盐 - 氰化物孵育并测量高铁血红蛋白来评估15名患者的红细胞氧化敏感性，透析前高铁血红蛋白平均为2.17±0.42 g/100 ml（标准误），透析后为2.87±0.52 g/100 ml（无显著性差异）。还测量了还原型谷胱甘肽（GSH）水平作为红细胞氧化损伤的指标。GSH从透析前的平均7.40±0.59微摩尔/克血红蛋白降至透析后的6.98±0.52微摩尔/克血红蛋白（P＜0.01）。在2名患者中，当在比例系统或其他无氯胺系统上进行透析时，51Cr红细胞存活率没有变化。我们得出结论，在使用比例透析输送系统时，添加抗坏血酸以中和自来水中的氯胺也是有效的。
