Effects of disinfectants in renal dialysis patients
Patients receiving hemodialysis therapy risk exposure to both disinfectants and sterilants. Dialysis equipment is disinfected periodically with strong solutions of hypochlorite or formaldehyde. Gross hemolysis resulting from accidental hypochlorite infusion has led to cardiac arrest, probably as a result of hyperkalemia. Formaldehyde is commonly used in 4% solutions to sterilize the fluid paths of dialysis controllers and to sterilize dialyzers before reuse. It can react with red cell antigenic surfaces leading to the formation of anti-N antibodies. The major exposure risk is the low concentration of disinfectant found in municipal water used to prepare 450 L dialysate weekly. With thrice-weekly treatment schedules, the quality requirements for water used to make this solution must be met rigorously. Standards for water used in the preparation of dialysate have recently been proposed but not all patients are treated with dialysate meeting such standards. The introduction of sterilants via tap water is insidious and has let to more pervasive consequences. Both chlorine and chloramines, at concentrations found in potable water, are strong oxidants that cause extensive protein denaturation and hemolysis. Oxidation of the Fe/sup 2 +/ in hemoglobin to Fe/sup 3 +/ forms methemoglobin, which is incapable of carrying either O/sub 2/ or CO/sub 2/. Chloramine can form not only methemoglobin, but can also denature proteins within the red cell, thus forming aggregates (Heinz bodies). Chloramines also inhibit hexose monophosphate shunt activity, a mechanism that makes the red cell even more susceptible to oxidant damage.
- Research Organization:
- Univ. of Louisville, KY
- OSTI ID:
- 5749743
- Journal Information:
- Environ. Health Perspect.; (United States), Vol. 69
- Country of Publication:
- United States
- Language:
- English
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DISINFECTANTS
BIOLOGICAL EFFECTS
DRINKING WATER
SAFETY STANDARDS
BIOLOGICAL PATHWAYS
CHLORAMINES
CHLORINE
DIALYSIS
ERYTHROCYTES
IRON COMPOUNDS
MECHANICAL KIDNEY
METHEMOGLOBIN
OXIDATION
PATIENTS
WATER TREATMENT
AMINES
ARTIFICIAL ORGANS
BIOLOGICAL MATERIALS
BLOOD
BLOOD CELLS
BODY
BODY FLUIDS
CARBOXYLIC ACIDS
CHEMICAL REACTIONS
ELEMENTS
GERMICIDES
GLOBIN
HALOGENS
HEMOGLOBIN
HETEROCYCLIC ACIDS
HETEROCYCLIC COMPOUNDS
HYDROGEN COMPOUNDS
KIDNEYS
MATERIALS
MEDICAL SUPPLIES
NONMETALS
ORGANIC ACIDS
ORGANIC CHLORINE COMPOUNDS
ORGANIC COMPOUNDS
ORGANIC HALOGEN COMPOUNDS
ORGANIC NITROGEN COMPOUNDS
ORGANS
OXYGEN COMPOUNDS
PIGMENTS
PORPHYRINS
PROSTHESES
PROTEINS
SEPARATION PROCESSES
STANDARDS
TRANSITION ELEMENT COMPOUNDS
WATER
560300* - Chemicals Metabolism & Toxicology