A case report on the placement of a temporal dialysis catheter in the femoral artery for emergency dialysis.

Background: Ensuring vascular access is essential for dialysis patients. This can be achieved through an arteriovenous anastomosis (fistulae), a central venous catheter, or an arteriovenous graft. However, in some cases vascular access to the patient's blood is not possible. Case Presentation: A multi-vascular male patient, who had been undergoing dialysis for 17 years, was presented to our renal department. There was no possibility of vascular access to the patient's venous network for dialysis. A peritoneal dialysis catheter was inserted, but it was malfunctioning. An attempt was made to place a HeRO AV Graft, but it did not succeed due to contraindications from the patient's venous network, as shown by the computed tomography. While trying to solve the problem in order to dialyze the patient during his hospitalization, he experienced severe shortness of breath with tachypnea (pulmonary edema), along with acidosis and hyperkalemia. A temporal dialysis catheter was urgently inserted into the left femoral artery and isolated ultrafiltration was performed, and by removing 1500 ml of ultrafiltration, the patient improved significantly. During the subsequent days, he underwent another 11 dialysis sessions using the femoral artery catheter. While he was hospitalized and being dialyzed via the femoral artery, a successful effort was made to catheterize the right external jugular vein, from which he continues to be dialyzed today. Conclusion: The patient's treatment through the placement of a temporal dialysis catheter in the femoral artery enabled him to survive. It is our belief that such a solution could be helpful in similar cases.

Acid-base and electrolyte disorders in patients with diabetes mellitus.

Diabetes mellitus is the most common metabolic disorder in the community. The diabetics may suffer from acid-base and electrolyte disorders due to complications of diabetes mellitus and the medication they receive. In this study, acid-base and electrolyte disorders were evaluated among outpatient diabetics in our hospital. The study consisted of patients with diabetes mellitus who visited the hospital as outpatients between the period January 1, 2004 to December 31, 2006. The patients' medical history, age and type of diabetes were noted, including whether they were taking diuretics and calcium channel blockers or not. Serum creatinine, proteins, sodium, potassium and chloride and blood gases were measured in all patients. Proteinuria was measured by 24-h urine collection. Two hundred and ten patients were divided in three groups based on the serum creatinine. Group A consisted of 114 patients that had serum creatinine < 1.2 mg/dL, group B consisted of 69 patients that had serum creatinine ranging from 1.3 to 3 mg/dL and group C consisted of 27 patients with serum creatinine > 3.1 mg/dL. Of the 210 patients, 176 had an acid-base disorder. The most common disorder noted in group A was metabolic alkalosis. In groups B and C, the common disorders were metabolic acidosis and alkalosis, and metabolic acidosis, respectively. The most common electrolyte disorders were hypernatremia (especially in groups A and B), hyponatremia (group C) and hyperkalemia (especially in groups B and C). It is concluded that: (a) in diabetic outpatients, acid-base and electrolyte disorders occurred often even if the renal function is normal, (b) the most common disorders are metabolic alkalosis and metabolic acidosis (the frequency increases with the deterioration of the renal function) and (c) the common electrolyte disorders are hypernatremia and hypokalemia.

Metformin induced severe hypophosphatemia in a patient on hemodialysis.

A 67-year-old diabetic and hypertensive woman presented to us with very low serum phosphate levels (PO4⁻ =1.1 mg/dL) about 40 days after initiation of hemodialysis (HD). The phosphate binders were discontinued, because they were thought to be the cause of hypophosphatemia. However, the serum phosphate levels continued to remain low during subsequent follow-up visits over one month (PO4⁻⁻⁻ = 0.7 and 0.6 mg/dL respectively). The patient had been started on metformin hydrochloride (850 mg thrice a day) about 18 days after the beginning of HD. The drug was stopped immediately (approximately 50 days after it was started) and the serum phosphate levels increased progressively, reaching 4.3 mg/dL. During the period with hypophosphatemia, the patient suffered from very intense fatigue and weakness (she was unable to walk), anorexia, diarrhea and tenesmus. There were no features suggestive of rhabdomyolysis, hemolysis, low blood pressure or hypoglycemia; she had low white blood cell and platelet counts. The patient was in good clinical condition 2-3 days after the discontinuation of metformin and she recovered totally 15 days later. This case is presented due to its rarity as well as the observation that despite the patient having severe hypophosphatemia, she showed only side effects of metformin. Hypophosphatemia caused only intense fatigue and no other symptoms.