• Can occur accidentally as a consequence of dialysate fluid containing improper ratios of acid and base concentrates in the form of acetate or bicarbonate^1,2.
• Can also develop as a result of the accidental use of an acidic concentrate instead of acetate or bicarbonate and due to computer software malfunction of the machine
• Severe metabolic acidosis has been reported during first 2 hours of HD using sorbent regenerative hemodialysis in mechanically ventilated patients³
• Treatment consists of intravenous administration of bicarbonate and dialysis with bicarbonate dialysate of a correct concentration (38-40 mEq/L)
• The mainstay of prevention is to fit all HD machines with a pH meter and alarms that will prevent the extreme acid load, which may be caused by an inappropriately prepared bicarbonate dialysate. Conductivity checks are vital.

References:

1. Hartmann A, Reisaeter A, Holdaas H, Rolfsen B, Fauchald P. Accidental metabolic acidosis during hemodialysis. Artif Organs 18:214-217, 1994
2. Gainza FJ, Zarraga S, Minguela I, Lampreabe I. Accidental substitution of acid concentrate for acetate in dialysis fluid concentrate: A cause of severe metabolic acidosis. Nephron 69:480-482, 1995
3. Reyes A, Turchetto E, Bernis C, Cereijo E. Acid-base derangements during sorbent regenerative hemodialysis in mechanically ventilated patients. Crit Care Med 19:554-559, 1991