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Title: Effects of disinfectants in renal dialysis patients

Abstract

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/submore » 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.« less

Authors:
Publication Date:
Research Org.:
Univ. of Louisville, KY
OSTI Identifier:
5749743
Resource Type:
Journal Article
Journal Name:
Environ. Health Perspect.; (United States)
Additional Journal Information:
Journal Volume: 69
Country of Publication:
United States
Language:
English
Subject:
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.; 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

Citation Formats

Klein, E. Effects of disinfectants in renal dialysis patients. United States: N. p., 1986. Web. doi:10.1289/ehp.866945.
Klein, E. Effects of disinfectants in renal dialysis patients. United States. doi:10.1289/ehp.866945.
Klein, E. Sat . "Effects of disinfectants in renal dialysis patients". United States. doi:10.1289/ehp.866945.
@article{osti_5749743,
title = {Effects of disinfectants in renal dialysis patients},
author = {Klein, E},
abstractNote = {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.},
doi = {10.1289/ehp.866945},
journal = {Environ. Health Perspect.; (United States)},
number = ,
volume = 69,
place = {United States},
year = {1986},
month = {11}
}