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      Hemolysis in Dialized Patients caused by Chloramines

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          Abstract

          Normal red cell survival is possible in dialyzed patients. Certain substances like copper and nitratenitrite induce hemolysis if present in the dialysate. We have identified another and probably a more frequent cause for hemolysis in dialyzed patients; chloramines. These compounds (a) are becoming more frequent in tap water as large water plants increasingly use chloramines rather than chlorine as bactericidal agents in tap water; (b) pass reverse osmosis membranes easily; (c) directly induce oxidant damage to red cells with methemoglobin formation; (d) damage the hexosemonophosphate shunt (HMPS) with which red cells defend themselves against oxidant damage; (e) consequently induce hemolysis and short red cell survival time; (f) sensitize the patients to oxidant drugs like primaquine, sulfonamides, etc.; (g) can be removed by charcoal filtration, boiling, or vacuum treatment, and (h) are most expediently neutralized by the addition of ascorbic acid in physiological amounts to the dialysate.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1974
          1974
          28 November 2008
          : 13
          : 6
          : 427-433
          Affiliations
          Departments of Medicine, Chemistry, and Surgery, University of Minnesota, Minneapolis, Minn.
          Article
          180421 Nephron 1974;13:427–433
          10.1159/000180421
          4431554
          © 1974 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 7
          Categories
          Original Paper

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