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I am a dialysis patient at a Fresenius clinic in Las Vegas Nevada who has been suffering with uncontrolled high blood pressure.

This is the email I sent to the clinic manager and social worker trying to get my sodium bicarbonate levels reduced to lower blood pressure. I would like my Bicarb set to 24.

Hello Sarah and Kelly,

Attached are Fresenius Internal Memos dealing with the issue of Sodium Bicarbonate, if you could pass these on to Dr Tandon that would be much appreciated.

FMC Oct 30 2008 in the section titled Sodium:

sodium concentration above the patientโ€™s serum baseline value leads to increased thirst, higher interdialytic weight gains, and possible increases in blood pressure. We continue to recommend that dialysate sodium be as close to the patientโ€™s serum sodium baseline as possible.

Based on this information from an Internal Memo from Fresenius dated October 30, 2008 I would like to set my sodium to 138. My average sodium level for 2015 is 135.625. If low sodium becomes an issue remove the low sodium diet.

FMC April 05 2002

"In my previous memos on this subject, I suggested that bicarbonate therapy should be individualized, particularly in patients with chronic respiratory acidosis such as those with chronic lung disease and severe congestive heart failure, who might experience decreased respiration if their post-dialysis bicarbonate levels were too high."

As we all know by now I'm not your typical Dialysis patient. I didn't present with low blood pressure quite the opposite was my situation. My renal artery ultrasound with Doppler showed no stenosis. By the time we got back from vacation I had developed shortness of breath and what I call rice Krispies when laying supine. That's when I knew my sodium bicarbonate was set to high. Setting the sodium bicarbonate might have seemed drastic to you, to me it was the only way to relieve the pressure that had build up. I went through this scenario Oct 2013 when my Bicarbonate was set at 38, not taking into account the 8 mEq/L of acetate.

FMC April 13 2009

"While predialysis serum bicarbonate in patients depends on many factors, we recommend that patients have a dialysis prescription that maintains the patient with a predialysis serum bicarbonate in the range of 20-23 meq/L."

Based on these recommendations I would like my sodium bicarbonate set to 22 meq/L.

By the time we got back from vacation I had developed shortness of breath and what I call rice Krispies when laying supine. That's when I knew my sodium bicarbonate was set to high. Setting the sodium bicarbonate to 22 meq/L might have seemed drastic to you, to me it was the only way to relieve the pressure that had build up so I could breath normally again without being winded walking just a few feet. If my sodium bicarbonate becomes low I can supplement with baking soda, this is the arrangement I had with Dr Mulchandani.

It may seem to you that its all about having to be in control, to me its about what's best for me.

I might not have gone to school to be a healthcare professional in the nephrology field, but I live with this disease everyday you have just read about it.

The more informed and involved I become the less you have to pay attention to me and can address those who could really use your help.

Thank you,

Salvador Martinez

Below is the link where I was able to gather all this information.

http://www.renalweb.com/writings/alkalosis/FMC%20Problem%20Misidentified.htm

Reason of review: Bad quality.

Preferred solution: Allow me the right to have a say in my treatment plan, especially when in 2 months you have not offered up one and I have..

Fresenius Medical Care Cons: Negligent care.

Location: Las Vegas, Nevada

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