2019
DOI: 10.1016/j.ekir.2018.09.001
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A Multidisciplinary Approach for the Management of Severe Hyponatremia in Patients Requiring Continuous Renal Replacement Therapy

Abstract: IntroductionHyponatremia is a common electrolyte disorder in critically ill patients. Rapid correction of chronic hyponatremia may lead to osmotic demyelination syndrome. Management of severe hyponatremia in patients with acute or chronic kidney disease who require continuous renal replacement therapy (CRRT) is limited by the lack of commercially available hypotonic dialysate or replacement fluid solutions.MethodsThis was a single-center quality improvement project that consisted of the development and impleme… Show more

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Cited by 22 publications
(31 citation statements)
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References 12 publications
(21 reference statements)
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“…Neyra et al 7 also demonstrated a gradual increase in plasma sodium level in 3 ICU patients with plasma sodium levels < 120 mEq/L using low-sodium dialysate CRRT in a single-center study. Their protocol entailed calculations to determine the exact volume of sterile water needed to replace or add to the standard-sodium dialysate bag.…”
Section: Discussionmentioning
confidence: 84%
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“…Neyra et al 7 also demonstrated a gradual increase in plasma sodium level in 3 ICU patients with plasma sodium levels < 120 mEq/L using low-sodium dialysate CRRT in a single-center study. Their protocol entailed calculations to determine the exact volume of sterile water needed to replace or add to the standard-sodium dialysate bag.…”
Section: Discussionmentioning
confidence: 84%
“…Their protocol entailed calculations to determine the exact volume of sterile water needed to replace or add to the standard-sodium dialysate bag. 7 Although it is possible to modify dialysate to different sodium concentrations on an “on-demand” basis as in their protocol, our strategy was to limit the low-sodium dialysate to 2 different values: 119 and 126 mEq/L. This was primarily done for safety reasons because having a range of modified sodium dialysates might have resulted in the need for repeated calculations, compounding errors, and the possibility of inadvertent over- or undercorrection of hyponatremia.…”
Section: Discussionmentioning
confidence: 99%
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“…The article by Neyra et al. 1 provides a novel therapeutic method for severe hyponatremia in patients who need renal replacement therapy; it also demonstrates a good format of the quality improvement report for the nephrology community.…”
mentioning
confidence: 99%
“…Continuous renal replacement therapy (CRRT) is the preferred modality, because the lowest dialysate sodium level is 130 mEq/l in most hemodialysis machines, which poses a risk for the over-rapid correction of hyponatremia. To provide effective dialysis while avoiding rapid increases in serum sodium concentration, several methods of prescribing CRRT were proposed,1, 2, 3 such as using low-sodium replacement fluid, and using standard replacement fluid and i.v. 5% dextrose in water infusion in the post-hemofilter to facilitate dilution of the blood exiting the hemofilter to keep serum sodium concentration at the preset concentration.…”
mentioning
confidence: 99%