2013
DOI: 10.1159/000355397
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Successful Treatment of Extreme Hyponatremia in an Anuric Patient Using Continuous Venovenous Hemodialysis

Abstract: Rapid correction of severe hyponatremia can result in osmotic demyelination syndrome. Patients with severe hyponatremia and renal failure requiring dialysis pose a therapeutic challenge since the use of conventional intermittent hemodialysis will result in a rapid correction of the serum sodium level. We report the case of a 52-year-old woman with extreme hyponatremia and severe acute kidney injury, who was successfully treated with continuous venovenous hemodialysis using a modified dialysate solution with a … Show more

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Cited by 8 publications
(5 citation statements)
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“…The intermittent haemodialysis machines in use at our facility (which incorporates the largest haemodialysis centre in the Southern Hemisphere) are only able to dialyse down to a sodium concentration of 120 mmol/L, and this would have precipitated too rapid a rise in serum sodium. The use of CRRT in preference to iHDx has considerable support in the literature for these reasons 15. Furthermore, it was thought that iHDx would have been particularly difficult for this patient given his acquired brain injury.…”
Section: Discussionmentioning
confidence: 88%
“…The intermittent haemodialysis machines in use at our facility (which incorporates the largest haemodialysis centre in the Southern Hemisphere) are only able to dialyse down to a sodium concentration of 120 mmol/L, and this would have precipitated too rapid a rise in serum sodium. The use of CRRT in preference to iHDx has considerable support in the literature for these reasons 15. Furthermore, it was thought that iHDx would have been particularly difficult for this patient given his acquired brain injury.…”
Section: Discussionmentioning
confidence: 88%
“…Another group treated a woman with acute presentation of kidney failure and hyponatremia (serum sodium, 92 mEq/L) with continuous venovenous hemodialysis, using a blood flow rate of 100–120 mL/min, dialysate flow rate of 1,000 mL/h, and initial dialysate sodium concentration of 105 mEq/L, and the dialysate sodium concentration was modified daily to maintain the sodium concentration at 6–8 mEq/L above the patient’s serum sodium level. 47 In the first case, there were no neurologic sequelae of osmotic demyelination syndrome, and in the second, magnetic resonance imaging of the head after treatment was free of evidence of osmotic demyelination syndrome. Both of these appear to be reasonable approaches.…”
Section: Treatment Of Hyponatremia In Patients With Esrdmentioning
confidence: 87%
“…Dialytic methods employed in the treatment of hyponatremia include CRRT methods, intermittent hemodialysis, and peritoneal dialysis. Table 4 contains reports of management of hyponatremia by dialytic methods (115)(116)(117)(118)(119)(120)(121)(122)(123)(124)(125)(126)(127)(128)(129)(130). One issue that requires further study in hyponatremia treated by hemodialysis is the effect of a decrease in plasma urea concentration during the procedure.…”
Section: Treatment Of Hyponatremia By Dialytic Methodsmentioning
confidence: 99%