============================================================================================================================ DIALYSATE SODIUM x BASE — buying back glucose without buying hyperchloraemic acidosis ============================================================================================================================ Cl = Na + K + 2Ca + 2Mg - base, so sodium and base set chloride with OPPOSITE signs. Shipped recipe: Na 136, base 32 -> dialysate Cl 111.5 Accept an arm only if ALL hold: serum Na <= 145, serum Cl <= 107, anion gap >= 10, serum HCO3 >= 20. Horizon 30 days. ============================================================================================================================ P4_anuric (72 kg, urine 0.0 L/day, eGFR fraction 0.0) ============================================================================================================================ Na base dialCl | serum Na serum Cl HCO3 AG | glucose vs base | UF dW | verdict 136 34 109.5 | 143.0 103.1 20.1 19.8 | 196 +0.0 | 59.9 -0.04 | ACCEPT 142 34 115.5 | 143.6 104.4 19.7 19.6 | 183 -6.6 | 71.4 -0.04 | reject: HCO3 19.7 148 34 121.5 | REJECTED BEFORE RUNNING — dialysate Cl 121.5 exceeds the 120 ceiling 152 34 125.5 | REJECTED BEFORE RUNNING — dialysate Cl 125.5 exceeds the 120 ceiling 156 34 129.5 | REJECTED BEFORE RUNNING — dialysate Cl 129.5 exceeds the 120 ceiling 136 38 105.5 | 143.0 100.9 22.4 19.7 | 196 -0.0 | 60.1 -0.04 | ACCEPT 142 38 111.5 | 143.7 102.1 22.0 19.5 | 183 -6.5 | 71.7 -0.04 | ACCEPT 148 38 117.5 | 144.3 103.4 21.6 19.4 | 171 -13.0 | 83.0 -0.06 | ACCEPT 152 38 121.5 | REJECTED BEFORE RUNNING — dialysate Cl 121.5 exceeds the 120 ceiling 156 38 125.5 | REJECTED BEFORE RUNNING — dialysate Cl 125.5 exceeds the 120 ceiling 136 42 101.5 | 143.0 98.6 24.8 19.6 | 196 -0.0 | 60.4 -0.04 | ACCEPT 142 42 107.5 | 143.7 99.9 24.3 19.4 | 183 -6.5 | 71.9 -0.04 | ACCEPT 148 42 113.5 | 144.3 101.2 23.8 19.3 | 171 -12.9 | 83.2 -0.05 | ACCEPT 152 42 117.5 | 144.8 102.0 23.6 19.2 | 163 -16.9 | 90.8 -0.23 | ACCEPT 156 42 121.5 | REJECTED BEFORE RUNNING — dialysate Cl 121.5 exceeds the 120 ceiling ============================================================================================================================ P1_typical_M70 (70 kg, urine 0.5 L/day, eGFR fraction 0.6) ============================================================================================================================ Na base dialCl | serum Na serum Cl HCO3 AG | glucose vs base | UF dW | verdict 136 34 109.5 | 143.2 103.5 20.2 19.5 | 180 +0.0 | 45.7 -0.65 | ACCEPT 142 34 115.5 | 144.0 104.6 19.8 19.6 | 172 -4.3 | 58.6 -1.32 | reject: HCO3 19.8 148 34 121.5 | REJECTED BEFORE RUNNING — dialysate Cl 121.5 exceeds the 120 ceiling 152 34 125.5 | REJECTED BEFORE RUNNING — dialysate Cl 125.5 exceeds the 120 ceiling 156 34 129.5 | REJECTED BEFORE RUNNING — dialysate Cl 129.5 exceeds the 120 ceiling 136 38 105.5 | 143.2 101.2 22.5 19.4 | 180 -0.0 | 45.9 -0.64 | ACCEPT 142 38 111.5 | 144.0 102.4 22.1 19.5 | 172 -4.3 | 58.8 -1.31 | ACCEPT 148 38 117.5 | 144.9 103.3 21.7 19.9 | 168 -6.8 | 72.2 -2.45 | ACCEPT 152 38 121.5 | REJECTED BEFORE RUNNING — dialysate Cl 121.5 exceeds the 120 ceiling 156 38 125.5 | REJECTED BEFORE RUNNING — dialysate Cl 125.5 exceeds the 120 ceiling 136 42 101.5 | 143.2 98.9 24.9 19.4 | 180 -0.1 | 46.1 -0.64 | ACCEPT 142 42 107.5 | 144.0 100.2 24.4 19.4 | 172 -4.3 | 59.0 -1.30 | ACCEPT 148 42 113.5 | 144.9 101.2 24.0 19.7 | 168 -6.8 | 72.4 -2.43 | ACCEPT 152 42 117.5 | 145.4 101.8 23.6 20.0 | 166 -7.7 | 81.3 -3.24 | reject: Na 145.6 156 42 121.5 | REJECTED BEFORE RUNNING — dialysate Cl 121.5 exceeds the 120 ceiling ============================================================================================================================ COVERAGE AND VERDICT ============================================================================================================================ matrix: 5 Na levels x 3 base levels = 15 combinations per patient; 12 arm-runs rejected before running on the chloride ceiling. P4_anuric 8/9 arms acceptable; best Na 152 / base 42 -> glucose 163 g/day (-16.9%), Na 144.9 Cl 103.4 AG 19.2 HCO3 23.6 P1_typical_M70 7/9 arms acceptable; best Na 148 / base 38 -> glucose 168 g/day (-6.8%), Na 145.0 Cl 104.0 AG 19.9 HCO3 21.7 RECIPES ACCEPTABLE FOR EVERY PATIENT TESTED: Na 136/base 34, Na 136/base 38, Na 136/base 42, Na 142/base 38, Na 142/base 42, Na 148/base 38, Na 148/base 42 A prescription must clear EVERY patient, not the easiest one — pick from this set.