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Abstract: PO0934

A Forgotten Technique of RRT for Correction of Severe Hyponatremia in CKD: Case Report

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Moreno, Rodolfo Alejandro, Centro Medico Militar, Guatemala, Guatemala, Guatemala
  • Trochez, Alexandra Michelle, Centro Medico Militar, Guatemala, Guatemala, Guatemala
  • Gonzales, Pedro, Centro Medico Militar, Guatemala, Guatemala, Guatemala
  • Palma, Antonio Jose, Centro Medico Militar, Guatemala, Guatemala, Guatemala
  • Sánchez, Lidia Beatriz, Centro Medico Militar, Guatemala, Guatemala, Guatemala
  • Hernández, Rafael José, Centro Medico Militar, Guatemala, Guatemala, Guatemala
  • Hernández, Jorge A., Universidad Mariano Galvez de Guatemala Facultad de Ciencias Medicas y de la Salud, Guatemala, Guatemala, Guatemala
Introduction

Patients with chronic kidney disease (CKD) present electrolytes disorders.This represents a challenge when hyponatremia is below 125mmol/L associated with any criteria for urgent renal replacement therapy (RRT) with conventional hemodialysis because of higher risk of over correction above the security threshold of 10mmol/L/day and osmotic demyelination syndrome.

Case Description

A 49-year-old Guatemalan female with history of 15 days of edema and slurred speech. Only history of T2DM. Was brought to the ER with BP 100/80mmHg and anasarca. Initial laboratories: negative COVID-19Ag, Cr 5.12mg/dl, (previous 2mg/dl) BUN 105mg/dl, glucose 156mg/dl, Na 108mmol/L, K 5.2meq/L, Cl 70meq/L. SOsm 224mOsm/kg, UOsm 875mOsm/kg, UNa 28meq/L. Because of neurologic symptoms, received a 150ml bolus of 3% saline twice with a rise to 112mmol/L. After the bolus, we initiated a 24-hour infusion with 3% hypertonic solution reaching a rise of Na up to 119mmol/L in 48 hours, but because of persistence of neurologic symptoms plus fluid overload >10% of body weight and hyperkalemia, we initiated RRT.In the absence of CRRT or CVVH we planned a conventional HD with blood flow of 100ml/min, dialysate flow 600ml/min, dialysate Na 130meq/L (the lowest Na possible) and 3 hours duration. After the first session had neurological and edema improvement. After two sessions with interdialytic period of 48 hours, Na control of 122mmol/L and 132mmol/L respectively with resolution of uremic syndrome. Later was diagnosed with hospital-acquired pneumonia receiving antibiotic treatment for 14 days and was discharged home with ambulatory HD.

Discussion

In undeveloped countries where the access to CRRT or CVVH is unavailable, conventional modalities can be used with low blood flows and modification of the dialysate Na to a minimum (130mmol/L) offering a safe option to Na correction for patients with severe hyponatremia and any other HD criteria.