Successful Treatment of Extreme Hyponatremia in an Anuric Patient Using Continuous Venovenous Hemodialysis

Viktorsdottir, Olof; Indridason, Ólafur S.; Pálsson, Runólfur

doi:10.1159/000355397

Cited by 8 publications

(5 citation statements)

References 42 publications

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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%

Hyponatraemia-induced rhabdomyolysis complicated by anuric acute kidney injury: a renal replacement conundrum

Secombe¹,

Milne

2016

BMJ Case Reports

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Hyponatraemia-induced rhabdomyolysis is a rare, but reported phenomenon, particularly in patients with chronic schizophrenia on depot antipsychotics prone to psychogenic polydipsia. To the best of our knowledge, there are no reported cases of hyponatraemia-induced rhabdomyolysis complicated by oligo-anuric acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). The initiation of CRRT is complicated in severe hyponatraemia, predominantly due to the need to avoid rapid changes in tonicity associated with rapid changes in sodium. We report a case of severe hyponatraemia (104 mmol/L) complicated by oligo-anuric rhabdomyolysis-induced AKI and our management of the renal prescription.

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Section: Discussionmentioning

confidence: 88%

Hyponatraemia-induced rhabdomyolysis complicated by anuric acute kidney injury: a renal replacement conundrum

Secombe¹,

Milne

2016

BMJ Case Reports

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“…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%

Dysnatremias in Patients With Kidney Disease

Combs

Berl

2014

American Journal of Kidney Diseases

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Dysnatremias are among the most common electrolyte disorders in clinical medicine. Recent studies have shown that individuals with chronic kidney disease also are afflicted by these electrolyte disorders. Furthermore, their presence imparts an increased risk of mortality. In this review, we discuss studies in experimental animals and in humans that have attempted to establish the mechanisms responsible for limiting urinary dilution and urinary concentration in progressive kidney disease. The clinical implications of these disorders in water excretion are discussed in the setting of optimal water intake as kidney disease progresses. This review emphasizes the management of patients with chronic kidney disease who have marked abnormalities in serum sodium concentrations and gives specific recommendations for modifications in renal replacement therapy prescription in hyponatremic patients with end-stage renal disease.

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“…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%

Dysnatremias in Chronic Kidney Disease: Pathophysiology, Manifestations, and Treatment

Arzhan

Lew²,

Ing³

et al. 2021

Front. Med.

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The decreased ability of the kidney to regulate water and monovalent cation excretion predisposes patients with chronic kidney disease (CKD) to dysnatremias. In this report, we describe the clinical associations and methods of management of dysnatremias in this patient population by reviewing publications on hyponatremia and hypernatremia in patients with CKD not on dialysis, and those on maintenance hemodialysis or peritoneal dialysis. The prevalence of both hyponatremia and hypernatremia has been reported to be higher in patients with CKD than in the general population. Certain features of the studies analyzed, such as variation in the cut-off values of serum sodium concentration ([Na]) that define hyponatremia or hypernatremia, create comparison difficulties. Dysnatremias in patients with CKD are associated with adverse clinical conditions and mortality. Currently, investigation and treatment of dysnatremias in patients with CKD should follow clinical judgment and the guidelines for the general population. Whether azotemia allows different rates of correction of [Na] in patients with hyponatremic CKD and the methodology and outcomes of treatment of dysnatremias by renal replacement methods require further investigation. In conclusion, dysnatremias occur frequently and are associated with various comorbidities and mortality in patients with CKD. Knowledge gaps in their treatment and prevention call for further studies.

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Successful Treatment of Extreme Hyponatremia in an Anuric Patient Using Continuous Venovenous Hemodialysis

Cited by 8 publications

References 42 publications

Hyponatraemia-induced rhabdomyolysis complicated by anuric acute kidney injury: a renal replacement conundrum

Hyponatraemia-induced rhabdomyolysis complicated by anuric acute kidney injury: a renal replacement conundrum

Dysnatremias in Patients With Kidney Disease

Dysnatremias in Chronic Kidney Disease: Pathophysiology, Manifestations, and Treatment

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