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Abstract: FR-PO588

Correction of Hyponatremia Using D5W Pre-Blood Pump on Patients on Continuous Renal Replacement Therapy: A Case Series

Session Information

  • Trainee Case Reports - III
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Lippold, Cassiopia Loretta, University of Baltimore, Baltimore, Maryland, United States
  • Patel, Ami, University of Baltimore, Baltimore, Maryland, United States
Introduction

Patients with severe hyponatremia and renal failure who require continuous renal replacement therapy (CRRT) are at risk of overcorrection of their sodium (Na) level. Herein, we present three cases of using a calculated amount of dextrose 5% solution (D5W) pre-filter as pre-blood pump (PBP) to prevent overcorrection of hyponatremia.

Case Description

Case 1: 53 year old female with end-stage liver disease secondary to alcohol and lupus presented with abdominal pain and vomiting with serum Na level of 114 mEq/L, which was overcorrected to 138 mEq/L by day 2. She was initially treated with free water flushes via a nasogastric tube and peripheral D5W, which improved her serum Na to 129 mEq/L. On day 4, she was started on continuous venovenous hemofiltration (CVVH) for oliguric renal failure with replacement rate around 1.5 L per hour, and added D5W PBP at 35 ml/hr, to keep her serum sodium at 135 mEq/L on the following day. Achieved Na was around 135-137 mEq/L.

Case 2: 39 year old male presented with alcohol withdrawal and hemorrhagic shock due to a variceal bleed. His admitting Na was 100 mEq/L, which corrected to 119 mEq/L by day 2. Patient was started on CVVH for acidosis, oliguric renal failure, and volume overload. Initial prescription was 2 L per hour replacement rate, D5W 500 ml per hour as PBP to aim for a goal Na of 112 mEq/l. The patient’s Na level improved to 112-115 mEq/L by day 3-4. Subsequently, D5W PBP was slowly titrated downward to aim for slow correction of hyponatremia.

Case 3: 45 year old male presented with acute alcoholic hepatitis, oliguric renal failure, and hyponatremia of 124 mEq/L. Patient was started on CVVH with D5W 100 ml per hour as PBP to achieve a goal Na of 131 mEq/L. In the next 24 hours, his Na was 127 mEq/L, and D5W was titrated downward with eventual slow correction of his hyponatremia.

Discussion

Slow correction of hyponatremia can safely be accomplished with the above calculation in patients with renal failure requiring CRRT using D5W PBP.

 D5W PBP (ml/hr)Replacement Rate (L/hr)Goal Na
(mEq/L)
Achieved Na (mEq/L)
Patient 1351.5136135-137
Patient 25002112112-115
Patient 31001.5131127