Abstract: PO1441
Continuous Renal Replacement Therapy (CRRT) for Overcorrection of Hyponatremia After Left Ventricular Assistance Device (LVAD) Placement
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Gelaidan, Abdulhadi Talal, Emory University School of Medicine, Atlanta, Georgia, United States
- Amarapurkar, Pooja D., Emory University School of Medicine, Atlanta, Georgia, United States
- Suarez, Jonathan J., Emory University School of Medicine, Atlanta, Georgia, United States
Introduction
Rapid correction of severe hyponatremia can result in osmotic demyelination syndrome, central pontine myelinolysis and locked-in syndrome. Rapid correction is defined as an increase in serum sodium (Na) by 10-12 mEq/L in the first 24 hours and 18 mEq/L in the first 48 hours. Rapid lowering serum Na in a short period after rapid correction of hyponatremia could prevent these complications. Conventional strategies use hypotonic intravenous fluids and desmopressin to lower overcorrected hyponatremia. However, CRRT can correct serum sodium in a very predictable and controlled manner.
Case Description
A 35-years old woman with a history of non-ischemic cardiomyopathy with an ejection fraction of 5-10% was admitted with an acute CHF exacerbation. Her hospitalization was complicated by AKI and hyponatremia. She underwent LVAD placement and her sodium increased from 111 to 137 mEq/L within 18 hours of surgery. She was started on CRRT using continuous venovenous hemodiafiltration (CVVHDF) with post-filter 5% dextrose in water to lower her sodium level to close to 120 meq/L. The patient tolerated the treatment very well with no immediate central nervous system complications or even delayed neurological complications at the two month follow up.
Discussion
To our knowledge, this is the first case report describing the use of CRRT for overcorrection of hyponatremia after LVAD placement. The overcorrection of hyponatremia after LVAD placement was likely due to the kidney's restored ability to excrete diluted urine from improved renal perfusion. Given the total fluid volume of hypotonic intravenous fluids and unpredictability of desmopressin we recommend considering early initiation of CRRT to treat overcorrection of hyponatremia after LVAD placement. Another consideration should be made for Initiation of CRRT prior to LVAD placement in patients with severe hyponatremia to prevent the rapid correction from occurring in the intraoperative setting.