Abstract: FR-PO655
Emergent Hemodialysis: Not Only for AKI
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Cordero Torres, Emmanuelle, Albany Medical College, Albany, New York, United States
- Salman, Loay H., Albany Medical College, Albany, New York, United States
- Chaudhry, Rafia I., Albany Medical College, Albany, New York, United States
- Monrroy, Mauricio, Albany Medical College, Albany, New York, United States
Group or Team Name
- Albany Medical Center Nephrology and Hypertension
Introduction
Severe hypothermia, i.e. core body temperature <28°C, is associated with a mortality rate of 50% despite optimal medical care. Commonly used external and internal rewarming techniques may not be effective in achieving the desired core body temperature, and more invasive rewarming modalities i.e. extra corporeal membrane oxygenation (ECMO) and cardiopulmonary bypass (CPB) are not available in all institutions. Hemodialysis (HD) is a safe, effective, and readily available option for the emergent management of hypothermia when conventional techniques have failed.
Case Description
A 78-year-old woman found unconscious, was airlifted to our institution with severe hypothermia (core body temperature of 28°C). She was unresponsive, requiring intubation for airway protection. Initial vital signs included BP 167/87 HR 40 RR 18 T 28°C. External rewarming with thermal blankets, and internal rewarming with 40 °C NS infusion resulted in increase in core body temperature from 28°C to 31°C over 5 hours. The patient remained unresponsive and bradycardic. Nephrology was consulted for role of extracorporeal renal replacement therapy in the setting of persistent hypothermia. We initiated hemodialysis via a right femoral HD catheter, with HD blood flow (Qb) of 300 ml/min, dialysate flow (Qd) 600 ml/min, and dialysate temperature of 37°C. The achieved Qb was 250 ml/min. The patient’s core body temperature was monitored via bladder probe, and rose from 32°C to 36.5°C after 3 hours of treatment i.e. hourly increase of 1.5°C. She regained consciousness soon after HD was completed, and was extubated. Frostbite lesions were evident in fingers and toes, although no other sequela of hypothermia persisted. No further complications, including electrolyte abnormalities, developed during, and after rewarming with HD.
Discussion
Hemodialysis is an effective therapeutic option to improve core body temperature, after external and internal rewarming techniques have failed. The rate of core body temperature increase can be closely monitored, and the ability to adjust the dialysate temperature offers the advantage to achieve a safe rate of correction (0.5 to 2°C). Timely rewarming can minimize duration and severity of adverse events including bradycardia and QT prolongation, which may result in a cardiac arrest if untreated. Furthermore, possible electrolyte derangements are simultaneously addressed with HD.