Therapeutic hypernatremia management during continuous renal replacement therapy with elevated intracranial pressures and respiratory failure

Background: Acid base disorders are frequently present in critically ill patients. Metabolic acidosis is associated with increased mortality, but it is unclear whether as a marker of the severity of the disease process or as a direct effector. The understanding of the metabolic component of acid base derangements has evolved over time, and several theories and models for precise quantification and interpretation have been postulated during the last century. Unmeasured anions are the footprints of dissociated fixed acids and may be responsible for a significant component of metabolic acidosis. Their nature, origin, and prognostic value are incompletely understood. This review provides a historical overview of how the understanding of the metabolic component of acid base disorders has evolved over time and describes the theoretical models and their corresponding tools applicable to clinical practice, with an emphasis on the role of ABG in general and several specific settings. Objectives: Aim of the study : to determine the value of ABG on mortality and morbidity in Pediatric Intensive Care Unit in minia university hospital. Methods: This was a retrospective study done over 2 years. There were total 653 patients (1 month to18 years), who were divided into survivals and non survivals groups. All data were collected and analyzed retrospectively including: Name, Age, sex, , length of stay in PICU, underlying etiology, cause of admission, and requirement for mechanical ventilation. laboratory investigations; from the patients' records, we obtained the results of routine blood samples on patients' admission to PICU which were immediately transported to the central laboratory in the hospital. These samples were arterial blood gases, Data retrieved from the medical files and statistically analyzed after permission from the ethical committee. Results: There were significant difference in the outcome of patients admitted to the PICU regarding the age group, sex, length of stay in PICU, requiring mechanical ventilation, respiratory failure P-value were (<0.001, <0.001, 0.007, <0.001, and <0.001 respectively). Conculsion:. There is no consensus regarding preferred methodology for the evaluation of acidebase derangements in critically ill patients. The physicalechemical approach by Stewart does not have a clear advantage over the traditional bicarbonate-based method. Both should be regarded as complementary for optimal understanding of acidebase disorders. Keywords; ABG, metabolic acidosis, outcome in children admitted on PICU.

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“…Intensive care is predominantly concerned with the management of patients with acute life threatening conditions in a specialized unit. (6) .…”

Section: Discussionmentioning

confidence: 99%

ABG in the Patients admitted on the Pediatric Intensive Care Unit, Minia University Hospital.

Farouk

Salam

Emad

2020

Minia Journal of Medical Research

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“…Dialytic methods for treating hypernatremia include CRRT (138)(139)(140)(141)(142), intermittent hemodialysis (124,143,144), and peritoneal dialysis (25,130,145). Management of hypernatremia by CRRT is done by customizing the dialysis fluid (139,141,142), or infusing hypertonic sodium solutions when there is an urgent need for the very slow rate of reduction in [Na], e.g., in patients with hypernatremia and cerebral edema (140). The rate of reduction of [Na] in hypernatremic patients treated with CRRT should be monitored.…”

Section: Treatment Of Hypernatremia 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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“…Thus, CKRT is preferred over IHD in patients with increased intracerebral pressure, including patients with fulminant hepatic failure, cerebral edema, and head trauma. 16 , 17 …”

Section: Modalities Of Krt In the Intensive Care Unitmentioning

confidence: 99%

Prescribing Continuous Kidney Replacement Therapy in Acute Kidney Injury: A Narrative Review

Verma

Palevsky

2021

Kidney Medicine

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Therapeutic hypernatremia management during continuous renal replacement therapy with elevated intracranial pressures and respiratory failure

Cited by 21 publications

References 63 publications

ABG in the Patients admitted on the Pediatric Intensive Care Unit, Minia University Hospital.

ABG in the Patients admitted on the Pediatric Intensive Care Unit, Minia University Hospital.

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

Prescribing Continuous Kidney Replacement Therapy in Acute Kidney Injury: A Narrative Review

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