Acute hypercapnic respiratory failure associated with hemodialysis

Patients undergoing hemodialysis are subject to recurrent acid-base perturbations. Prior to each dialysis treatment, they are relatively acidemic, which is corrected rapidly during dialysis. We report a patient with obesity, obstructive lung disease, and pneumonia who developed acute respiratory failure triggered by an influx of high bicarbonate during dialysis. This case emphasizes that in patients with severely compromised respiratory reserve, a large amount of bicarbonate influx during hemodialysis may cause acute CO₂ accumulation and ventilatory distress. An individualized approach with judicious adjustment of the dialysate bicarbonate concentration may be necessary. Dial. Transplant. © 2011 Wiley Periodicals, Inc.