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Abstract: FR-PO282

Continues Renal Replacement Therapy: A Simple Approach for Treating Hyponatremia

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Amarapurkar, Pooja D., Jackson Memorial Hospital/University of Miami, Miami, Florida, United States
  • Olickal, Jiny, Jackson Memorial Hospital, Miami Beach, Florida, United States
  • Watford, Daniel Joseph, Jackson Memorial Hospital/University of Miami, Miami, Florida, United States
  • Soberon, Daniel J., Miami VA medical Center , Miami, Florida, United States
  • Venkat, Vasuki N., Miami VA medical Center , Miami, Florida, United States
  • LadinoAvellaneda, Marco A., Miami VA Medical Center/University of Miami/ Jackson Memorial Hospital, Plantation, Florida, United States
Background

Severe hyponatremia (serum sodium(Na) <125) is frequently seen in critically ill patients. Often, this is unresponsive to fluid restriction, diuretics or 3% saline. The combination of hyponatremia and acute kidney injury (AKI) needing continuous renal replacement therapy (CRRT) makes management of hyponatremia challenging. Indication for CRRT include acidosis, volume overload & electrolyte abnormalities. Dialysate/replacement fluid solutions used during CRRT have a standard Na concentration of 140 meq/L. When dosed at 25-30 ml/kg/hr there is a risk of rapid correction of Na level & osmotic demyelination syndrome. There is limited data for CRRT in correcting hyponatremia. Few complex formulas help to calculate the appropriate CRRT dose for Na correction, providing adequate clearance. We report our experience of managing 33 cases with severe hyponatremia using CRRT.

Methods

Out of 33 patients with severe hyponatremia, 28 had AKI stage III needing CRRT & 5 had ESRD. 30 patients required vasopressor support. CRRT was initiated in all for correction of Na at 15-25 ml/kg/hr. Pre-pump infusion of D5W was added to dilute the replacement fluid. All the patients had the serum Na level checked every hour for the first 3 hours and then every 3-4 hours once a Na 125 mmol/l was reached.

Results

A steady 6-8 mmol/day rise in serum Na level was obtained along with the correction of other abnormalities & no complications.

Conclusion

This case series highlights the applicability of a simplified practical approach without using complex formulas to safely manage severe hyponatremia using CRRT despite a standard Na concentration in the dialysate/replacement solution. Close serum Na monitoring is imperative to adjust the delivered CRRT and D5W infusion doses.