RESUMEN
Twelve episodes ofsevere metabolic acidosis were observed among 10 maintenance dialysis patients using Bicarbonate Haemodialysis (HDB). Patients were stable at the start of haemodialysis (HO) and became sick during or following the procedure. The main clinical features observed were abdominal pain and vomiting, hypotension or shock, and CNS manifestations. Laboratory investigations revealed severe metabolic acidosis in all and hyperkalemia in 4 patients. On four occasions, dialysate fluid sample analysis revealed purely acidic dialysate being delivered to the patients. Patients were treated by sodium bicarbonate, redia lysis on another machine and vasopressors when severely hypotensive. One patient died and the rest improved. This potentially lethal complication needs to be considered early in all patients who become sick during or following HOB.