Does anyone have any documentation from Fresenius on the explanation of the effect of Granuflo acid on final bicarb levels in dialysate? For example, with 45X proportioning, I have 37 mEq/L of bicarb in my dialysate. However, this is not my Base Bicarbonate level on the dialysate screen of a 200K. In order to have final electrolyte levels, equal to the values in my acid, I need to enter 33 or 34 mEq/L in the Base Bicarbonate "box" on the dialysate screen. According to Fresenius, 4mEq/L is supplied by the Sodium acetate and the acetic acid that comprises the 8 mEq/L of acetate contained in Granuflo. If you are confused, join the club. If anyone can expound on this, I'd appreciate it. If anyone has a document which explains the "buffering effect of granuflo" in the mixed dialysate, I would love to get a copy of it. Thanks

My medical director told me when we first went to Granuflo that the human body metabolizes acetate to bicarbonate, so you would need ti verify that with your MD.

Not quite sure what you are looking for here? When you entered your Granuflo values did you enter 8 mEq/l like it say on the box or did you only enter 4 (1/2 the value) like you are supposed too?

The meq/l of the bicarb is an order that the md has to make.

I believe what you are talking about is the difference between the bicarb setting on the machine and the "total buffer". The total buffer is the bicarb setting on the machine plus the acetate that will metabolize into bicarb in the body. So if you set your bicarb at 34 using a 4000 series Granuflo - 0FD2251-3B for example, it would be like this.

Base NA = 138 and Bicarb = 34
TCD=13.6, Total buffer=42, K=2.0, Ca=2.5, Mg=1.0 Acetate=8, & Dextrose=100

If you change the base sodium or the bicarb the numbers will change. The point is that even though your bicarb setting is only 34 it is like the patient is receiving the total buffered bicarb of 42 because of the acitate metabolizing in the body.

Give me the type of Granuflo you are using and the Na and Bicarb settings and I can tell you what your Total Buffer would be to the patient.

I did enter 4mEq/L for the acetate in the Granuflo. I set my Base Sodium for 138mEq/L and my base bicarb 34 mEq/L. I am using 0FD2419-3B Granuflo and 4112 naturalyte bicarb. My most recent previous settings were 138mEq/L base sodium and 37 mEq/L bicarb because that was the # of mEq/L combined on the Granuflo and Bicarb labels. With these settings my TCD was very low 13.2 and my electrolyte values were all less then what was contained in the granuflo. I am now using the 138mEq/L base sodium and 34 mEq/L base bicarb and I have a higher TCD and my electrloytes are appropriate for the Grnuflo. I was asking if anyone had the "documentation' from Fresenius where this buffer effect is described. Thanks for the help.

This may give you what you need.

[URL=https://fmc4me.fmcna.com/idc/idcplg?IdcService=GET_FILE&dDocName=PDF_300022563&allowInterrupt=1&Rendition=web&RevisionSelectionMethod=latestReleased]

Sorry about that. I don't know how to insert a web address obviously. Just go to fmc4me and in the search type, "Understanding Dialysate Bicarbonate". I believe that is what you are looking for.

I appreciate that link, Unfortunately, I couldnt find the explanation on the site. I'll try again. Thanks.

Says I need to be fmc employee to log on. Any way around that? Thanks for taking the time to educate the little guy!!