The nurse is reviewing a list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response knowing that the glucose:
A. Prevents excess glucose from being removed from the client.
B. Decreases risk of peritonitis.
C. Prevents disequilibrium syndrome.
D. Increased osmotic pressure to produce ultrafiltration.
Correct Answer: D. Increases osmotic pressure to produce ultrafiltration.
Increasing the glucose concentration makes the solution increasingly more hypertonic. The more hypertonic the solution, the greater the osmotic pressure for ultrafiltration and thus the greater amount of fluid removed from the client during an exchange.
Option A: Conventional PD solutions contain high levels of glucose (dextrose; 75.5–214 mmol/L) as a principal osmotic agent to achieve fluid removal (i.e. ultrafiltration across the peritoneal membrane).
Option B: The appreciable peritoneal glucose absorption has been linked with adverse local peritoneal membrane effects and systemic metabolic effects. Glucose in PD solutions triggers protein glycosylation and activates the polyol and protein kinase C pathways.
Option C: Systemic glucose absorption has also been associated with worsening hyperglycemia in diabetic patients, new?onset hyperglycemia in incident non?diabetic PD patients, visceral obesity and dyslipidemia, characterized by elevated levels of total cholesterol, triglyceride, very low?density lipoprotein (VLDL) and low?density lipoprotein (LDL).
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