Chlorine and chloramines must be monitored in order to prevent which condition?

Monitoring chlorine and chloramines in the water supply used for hemodialysis is crucial to prevent methemoglobinemia. These substances can be harmful because they interfere with the ability of hemoglobin to carry oxygen in the blood.

When chlorine and chloramines are present in significant amounts, they can oxidize the iron in hemoglobin from its ferrous (Fe2+) state to ferric (Fe3+) state. This oxidation transforms hemoglobin into methemoglobin, which cannot effectively bind to or release oxygen, leading to reduced oxygen delivery to tissues. Symptoms of methemoglobinemia can include cyanosis, shortness of breath, fatigue, and in severe cases, it can be life-threatening.

The other conditions listed are not directly linked to chlorine or chloramine exposure in the context of hemodialysis. While hyperkalemia involves elevated potassium levels, hypotension refers to low blood pressure, and anemia is a condition characterized by a deficiency of red blood cells or hemoglobin, methemoglobinemia is the specific condition that arises from the effects of these disinfection byproducts on hemoglobin function. Thus, the monitoring of these chemicals is vital to avoid methemoglobinemia in patients undergoing dialysis.