Department of Corrections

Abstract

A reader asks: I recently had the opportunity to read Donn and Banagale's informative article entitled, "Neonatal Hyperammonemia" (Pediatrics in Review 1984; 5:203-208). I am somewhat confused by Table 5 which lists the ingredients for 1.5% dextrose-bicarbonate peritoneal dialysate. The use of a total of 167 mEq/L of sodium seems nonphysiologic and combination of calcium and bicarbonate, if I remember correctly, leads to precipitation. Dr. Donn replies: There was an error in Table 5 in our review article. Unfortunately, the error was missed by both authors, internal reviewers, and external reviewers as well. As indicated, the total sodium concentration of the dialysis solution is too high. The total sodium concentration, the combination of sodium chloride and sodium bicarbonate should approximate 132 to 136 mEq/L. At the present time, our special peritoneal dialysis solution contains 95 mEq/L of sodium chloride and 40 mEq/L of sodium bicarbonate for a total of 135 mEq/L. This is certainly within the physiologic realm and avoids problems with sodium flux. With regard to concern about the precipitation of calcium and bicarbonate, the concentrations of both calcium chloride and sodium bicarbonate are low enough that they do not exceed the solubility product and, therefore, remain in solution.