Kidney Week

Abstract: SA-PO440

Case Series of Continuous Venovenous Hemofiltration With Severe Hyponatremia and Acidosis

Session Information

• Hemodialysis and Frequent Dialysis: Clearance, Technology, Infection
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Konishi, Kasumi, St.Luke's International Hospital, Tokyo, Japan

Kasumi Konishi,

• Fujimaru, Takuya, St.Luke's International Hospital, Tokyo, Japan

Takuya Fujimaru,

• Shimoyama, Kotaro, St.Luke's International Hospital, Tokyo, Japan

Kotaro Shimoyama,

• Kadota, Nozomi, St.Luke's International Hospital, Tokyo, Japan

Nozomi Kadota,

• Ito, Yugo, St.Luke's International Hospital, Tokyo, Japan

Yugo Ito,

• Taki, Fumika, St.Luke's International Hospital, Tokyo, Japan

Fumika Taki,

• Nagahama, Masahiko, St.Luke's International Hospital, Tokyo, Japan

Masahiko Nagahama,

• Isokawa, Shutaro, St.Luke's International Hospital, Tokyo, Japan

Shutaro Isokawa,

• Hifumi, Toru, St.Luke's International Hospital, Tokyo, Japan

Toru Hifumi,

• Otani, Norio, St.Luke's International Hospital, Tokyo, Japan

Norio Otani,

• Nakayama, Masaaki, St.Luke's International Hospital, Tokyo, Japan

Masaaki Nakayama,

Introduction

For the patients with anuric acute kidney injury (AKI) and severe hyponatremia, we previously reported “Flex Na” method, which involved flexible adjustment of the sodium concentration used continuous venovenous hemofiltration(CVVH). However the weak point of this methods is the management of severe acidosis. In this case series, we had performed “Flex Na” added on intravenous 1.26% NaHCO3 and improved severe acidemia and hyponatremia.

Case Description

case1
A 57 year-old man admitted to the hospital with bacterial meningitis and AKI due to acute tubular necrosis. The blood test showed sodium 121 mEq/L, potassium 3.6 mEq/L, chloride 84 mEq/L, urea nitrogen 68.8mg/dL, creatinine 4.84 mg/dL. Aterial blood gas analysis showed pH 7.04, PaCO2 of 37.4mmHg, PaO2 of 103.0 mmHg, bicarbonate level of 9.6 mEq/L, lactate 10.9 mmol/L.We started Flex Na using the 5% dextrose solution(D5W) infusion and available replacement fluid(Sublood-BSG), which has a sodium concentration of 140 mEq/L as 1.26% NaHCO3 was infused intravenously. After 48 hours, acidosis was improved. After another 24hours, serum sodium reached 130 mEq/L,and we changed intermittent hemodialysis(IHD).

case2
A 48 year-old man with stage 5 chronic kidney injury admitted to hospital with unconsciousness due to uremia. The laboratory data showed sodium 108 mEq/L, potassium 6.0 mEq/L, chloride 78 mEq/L, urea nitrogen 139.3 mg/dL, creatinine,17.85 mg/dL. Aterial blood gas analysis showed pH 6.8, PaCO2 of 33.3mmHg, PaO2 of 43.3 mmHg, bicarbonate level of 5.5 mEq/L, Lactate of 4.10mmol/L. We started “Flex Na” method with continuous infusion of D5W and 1.26% NaHCO3 intravenously for the additional filtration. After 48 hours treatment, acidosis was improved and we changed IHD for maintenance renal replacement therapy.

Discussion

In general, adverse effects of acute metabolic acidosis include decreased cardiac output, arterial dilatation with hypotension, altered oxygen delivery, and impairment of the immune response. Therefore, the patients with severe metabolic acidosis need bicarbonate therapy or dialysis. However, CVVH had slower clearance than IHD. From this case report, Flex Na with intravenous NaHCO3 infusion could be the optimal tool for the patients with severe hyponatremia and acidosis who require dialysis.