Treatment of severe hyponatremia with continuous renal replacement therapy: A case and review of corrective strategies

IF 1.2 4区 医学 Q3 UROLOGY & NEPHROLOGY
Paul J. Der Mesropian, Shawn Phillips, Martha Naber, Sunjeev Konduru, Gulvahid Shaikh, Krishnakumar Hongalgi
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引用次数: 0

Abstract

Treatment of severely hyponatremic patients with continuous renal replacement therapy (CRRT) presents a unique challenge given the lack of commercial options for hypotonic replacement solutions or dialysate. We report the case of a 55-year-old male who presented with profound, symptomatic hyponatremia in the setting of acute kidney injury (AKI). The patient was found to have a serum sodium concentration of 97 mEq/L because of free water retention that occurred during severe AKI from viral gastroenteritis and rhabdomyolysis. Continuous veno-venous hemofiltration (CVVH) was required for AKI complicated by hyperkalemia, metabolic acidosis, and uremia. To prevent overcorrection of serum sodium, replacement fluids customized to natremic status had to be prepared. Conventional replacement fluid was modified on a daily basis to create hypotonic solutions with successively higher sodium concentrations. Over the course of a week, serum sodium successfully improved in a controlled and safe fashion. This case incorporates and reviews the variety of methods that have been used to safely manage severe hyponatremia with CRRT.

用持续肾脏替代疗法治疗严重低钠血症:一个病例和纠正策略回顾。
由于缺乏低渗替代溶液或透析液的商业选择,使用持续肾脏替代疗法(CRRT)治疗严重低钠血症患者是一项独特的挑战。我们报告了一例 55 岁男性患者的病例,他在急性肾损伤 (AKI) 的情况下出现了严重的、无症状的低钠血症。由于病毒性胃肠炎和横纹肌溶解症导致的严重急性肾损伤期间出现游离水潴留,患者的血清钠浓度为 97 mEq/L。由于 AKI 并发高钾血症、代谢性酸中毒和尿毒症,因此需要进行连续静脉-静脉血液滤过(CVVH)。为防止过度纠正血清钠,必须准备适合尿毒症状态的替代液体。传统的补充液每天都要进行调整,以产生钠浓度逐渐升高的低渗溶液。在一周的时间里,血清钠成功地以可控和安全的方式得到了改善。本病例结合并回顾了使用 CRRT 安全处理严重低钠血症的各种方法。
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来源期刊
Hemodialysis International
Hemodialysis International UROLOGY & NEPHROLOGY-
CiteScore
2.50
自引率
0.00%
发文量
58
审稿时长
6-12 weeks
期刊介绍: Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.
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