Abstract: PO1432
Acute Hemodialysis Prescription in Severe Hyponatremia Patient
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
- Wardoyo, Yasmine, Rumah Sakit Dr Cipto Mangunkusumo, Central Jakarta, Indonesia
- Gaol, Donnie Lumban, Rumah Sakit Dr Cipto Mangunkusumo, Central Jakarta, Indonesia
- Siregar, Parlindungan, Rumah Sakit Dr Cipto Mangunkusumo, Central Jakarta, DKI Jakarta, Indonesia
Introduction
Severe hyponatremia in end-stage renal disease with fluid overload give rise to clinical dilemma. Dialysis and ultrafiltration are needed to reduce uremic toxins and fluid overload, yet there is a danger of osmotic demyelination syndrome if blood sodium level rapidly increase above the permissible range.
Case Description
60 years old male patient was admitted with acute pulmonary oedema due to chronic kidney disease. He came with ureum 140 mg/dl, creatinin 20.3 mg/dl and had severe hyponatremia 94 mEq/L. He underwent hemodialysis with low blood flow rate (50 ml/min) and low dialysate sodium (130 mEq/L). Second hemodialysis was done with blood flow rate 100 ml/min and dialysate sodium 130 mEq/L. With this approach, we succeeded in increasing sodium gradually, not exceeding the limit of 10 mEq/day.
Discussion
In order to avoid rapid increment of serum sodium level, the sodium in dialysate can be set as low as possible to 130 mEq/L. We aim to limit the increment of serum Na to 10 mEq/day. Since the patient’s total body water is approximately 36 L, an increase of 3 mEq/L/hour during 3-hour dialysis session would require a transfer of 108 mEq of Na per hour or total 324 mEq. We set a very slow blood flow rate, set dialysate rate to 800 ml/min and we assume that there is a 100% equilibration of Na between the patient’s blood and the dialysate, resulting in net transfer of 36 mEq Na (Nadialysate - Naserum) to each liter of blood that flow through the dialyzer. As the desired total Na transfer was 324 mEq, and 36 mEq would be added for every litre of blood dialyzed, we estimated that 9000 ml of blood needed to be dialyzed. The amount of blood divided by 3 hour hemodialysis treatment time leads to a blood flow rate 50 ml/min. With this approach, post dialysis sodium level increase 10 mEq/L. Similar approach gave similar finding in second hemodialysis. In conclusion, hemodialysis in severe hyponatremia patient needs several modifications in order to limit the increment of sodium within safe and permissible range.
Serum sodium level increment