Renal failure and dialysis have a great impact on the metabolism of trace elements. They accumulate in various parts of the body and can cause toxic reactions.
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(2) Copper: The plasma copper level of patients with chronic renal failure without dialysis is often normal, but it can also be slightly lower. Patients who use copper imitation membrane for hemodialysis may have copper accumulation, but no clinical effect of copper accumulation has been observed. When using dialysis fluid with high copper content for hemodialysis, acute copper poisoning may be caused. The clinical manifestations are high fever and severe hemolytic anemia, and may also have granulocytosis, metabolic acidosis, and pancreatitis, Diarrhea and vomiting. In vitro experiments found that red blood cells exposed to copper can lead to the loss of reducing glutamine, increase of Heinz corpuscle formation, increase of autohemolysis, inhibit the reduction of glutathione reductase and glucose-6-phosphate dehydrase. Copper can also directly damage the red blood cell membrane. When the pH of tap water is lower than 6.5, the copper in the copper tube and its parts can be filtered out, so it is not suitable for dialysis.
(3) Zinc: The plasma zinc content of patients with chronic renal failure who eat low-protein diet and nephrotic syndrome who lose a large amount of urine protein is often very low. Some people report that the plasma zinc content and the level of zinc in red blood cells of some hemodialysis patients are significantly increased, which may be caused by the zinc content in the dialysate exceeds the content in the plasma filtrate. The dialysate used now is deionized water or reverse osmosis water, and the zinc content in the plasma and tissues of patients is normal or low, Many patients taking ferrous sulfate can lead to malabsorption of zinc, and the loss of zinc in dialysate can lead to zinc deficiency. If oral zinc salt is supplemented, it is better to suspend ferrous sulfate to promote zinc absorption.
The deficiency of zinc in hemodialysis patients can cause the loss or disappearance of taste and smell, impotence and low plasma testosterone levels with high plasma gonadotropin and luteinizing hormone levels can also be attributed to the deficiency of zinc, but there is no exact evidence. It is better to measure the plasma zinc content of dialysis patients every six months by proton absorption spectroscopy, but the determination of plasma zinc content is only a rough indicator to judge the zinc deficiency, The determination of zinc content in granulocytes and platelets is more sensitive than that in plasma. Whether zinc deficiency causes growth retardation in children undergoing routine hemodialysis should be considered.