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Abstract: FR-PO582

Customized Renal Replacement Therapy in a Patient with a Serum Sodium of 97 mEq/L

Session Information

Category: Trainee Case Report

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Phillips, Shawn J., Albany Medical Center, Albany, New York, United States
  • Naber, Martha, Albany Medical Center, Albany, New York, United States
  • Rigual soler, Natacha, Albany Medical Center, Albany, New York, United States
  • Mehta, Swati, Albany Medical Center, Albany, New York, United States
  • Hongalgi, Krishnakumar D., Albany Medical Center, Albany, New York, United States
Introduction

Hyponatremic patients requiring continuous veno-venous hemofiltration (CVVH) offer a unique challenge as commercial replacement solution contain physiologic concentrations of sodium. Use of such fluids may cause rapid correction of hyponatremia resulting in osmotic demyelination. We present a patient with Acute kidney injury (AKI) and severe hyponatremia who was successfully treated using custom made CVVH solutions.

Case Description

A 55-year-old male with no significant medical history was found unconscious. He suffered cardiac arrest with return of spontaneous circulation after CPR. He was diagnosed to have sepsis secondary to diarrheal illness and severe rhabdomyolysis. Patient was found to have oliguric AKI, severe anion gap metabolic acidosis and multiple electrolyte abnormalities. Labs included serum sodium of 97 mEq/L, CO2 of 8, potassium of 6.2 and pH of 7.2. He received 100 mL of 3% sodium chloride with improved serum sodium to 105 mEq/L. CVVH was initiated for oliguric AKI, hyperkalemia and metabolic acidosis. On days 1 and 5 CVVH prefilter replacement solutions were compounded by draining fluid from a Prismasol bag and replacing with 5% dextrose (D5W) to dilute the sodium. On days 2, 3 and 4 solutions were compounded by pooling 2L of D5W and 2L of normal saline and adding potassium, magnesium, and chloride to achieve a concentration of 4 mEq/L, 2 mEq/L, and 81 mEq/L respectively. Sodium acetate was then added to adjust the sodium concentration and osmolarity based on the daily serum target. Other electrolytes were replaced separately due to compatibility risks. Incremental serum sodium targets were achieved on each day. The patient achieved serum sodium target on day 6 and was started on standard CVVH fluid containing 140 mEq/L sodium. The patient was later discharged home with no need for further renal replacement therapy.

Discussion

Rapid correction of severe hyponatremia can cause osmotic demyelination syndrome. CVVH to treat oliguric AKI with severe hyponatremia using commercial premixed replacement fluid bags is a challenge. This case illustrates the utility of customized CVVH solutions as a method for the correction of severe hyponatremia in critically ill patients requiring CVVH.