Acute peritoneal dialysis as both cause and treatment of hypernatremia in an infant

Moritz, Michael L.; Rio, Marcella Del; Crooke, Gregory A.; Singer, Lewis P.

doi:10.1007/s004670100644

Cited by 19 publications

(8 citation statements)

References 15 publications

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“…Treatment using standard lactate-buffered PD solutions (with 132 mEq/L sodium) corrected serum sodium by no more than15 mEq/L in 24 hours in our patients. Several case reports have presented the use of PD to treat hypernatremia in children (23)(24)(25). Moritz et al reported an infant with multiorgan failure who developed severe hypernatremia because of rapid free-water removal with acute PD.…”

Section: Discussionmentioning

confidence: 99%

“…Moritz et al reported an infant with multiorgan failure who developed severe hypernatremia because of rapid free-water removal with acute PD. However, PD treatment with low-sodium hyper-tonic solution was also used to correct hypernatremia and fluid overload in that infant (23). In the other reports, the need for fluid removal was not a consideration, and serum sodium was corrected with the contribution of free water administration (24,25).…”

Section: Discussionmentioning

confidence: 99%

“…They were also found to be more effective than percutaneously inserted catheters (22,26). It is suggested that a Tenckhoff catheter be considered once dialysis is expected to extend beyond 5 days (23).…”

Section: Discussionmentioning

confidence: 99%

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Acute Peritoneal Dialysis in Neonates with Acute Kidney Injury and Hypernatremic Dehydration

Yıldız¹,

Ergüven²,

Yıldız³

et al. 2012

Perit Dial Int

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♦ Objective: We aimed to evaluate the efficacy of acute peritoneal dialysis (PD) and clinical outcomes in neonates with acute kidney injury (AKI) and hypernatremic dehydration. ♦ Methods: The medical records of 15 neonates with AKI and hypernatremic dehydration who were treated with acute PD were reviewed. The diagnoses were AKI with hypernatremic dehydration with or without sepsis in 13 patients and AKI with hypernatremia and congenital nephropathy in 2 patients. The main indications for PD were AKI with some combination of oligoanuria, azotemia, hyperuricemia, and metabolic acidosis unresponsive to initial intensive medical treatment. ♦ Results: The mean age of the patients at dialysis initiation was 11.9 ± 9 days, and the mean duration of PD was 6.36 ± 4.8 days. In 7 patients (46.7%), hypotension required the use of vasopressors, and in 6 patients (40%), mechanical ventilation was required. Peritoneal dialysisrelated complications occurred in 7 patients (46.7%), the most common being catheter malfunction (n = 6). Four episodes of peritonitis occurred in the 15 patients (26.7%), 2 episodes in patients with congenital renal disease and 2 episodes in patients with sepsis and multiorgan failure, who did not survive. Congenital renal disease, septicemia, and the need for mechanical ventilation were important factors influencing patient survival. All patients with no pre-existing renal disease or sepsis recovered their renal function and survived. ♦ Conclusions: In neonates with AKI and hypernatremic dehydration, PD is safe and successful, and in patients without congenital renal disease or sepsis, the prognosis is good. Peritoneal dialysis should be the treatment of choice in neonates with AKI and hypernatremic dehydration who do not respond to appropriate med ical treatment. A cute kidney injury (AKI) in neonates has many causative factors. Hypernatremic dehydration associated with breastfeeding is one such cause. Although successful breastfeeding provides compelling advantages to infants and mothers, inadequate breastfeeding may result in lifethreatening dehydration. Hypernatremic dehydration is a rare complication of breastfeeding (1,2), but recent reports have shown that its incidence is increasing (2-5). Prolonged hypovolemia and decreased renal perfusion can cause intrinsic renal injury.Once intrinsic renal failure becomes established, treatment of the metabolic complications of AKI involves appropriate management of fluid, electrolytes, and acidbase balance; provision of good nutrition; and initiation of renal replacement therapy (RRT) if conventional therapy fails to control metabolic complications and fluid overload (6). The preferential use of hemodialysis (HD) and hemofiltration by pediatric nephrologists is increasing, but those modalities are technically difficult procedures. The large extracorporeal circuit volumes, anticoagulation, and vascular access required are limiting factors, particularly in neonates. As a result, peritoneal dialysis (PD) is generally the most common form of RRT in young child...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Acute Peritoneal Dialysis in Neonates with Acute Kidney Injury and Hypernatremic Dehydration

Yıldız¹,

Ergüven²,

Yıldız³

et al. 2012

Perit Dial Int

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“…20 PD is an efficient mode for correction of sodium plasma concentration. It has been previously reported in children with saline intoxication, 21 infants with multiorgan dysfunction, 22 and in neonates with Netherton syndrome. 17 Early initiation of PD is recommended in the hypernatremic oliguric or anuric patient, given fluid overload resulting from aggressive fluid therapy.…”

Section: Discussionmentioning

confidence: 86%

Extreme Neonatal Hypernatremia and Acute Kidney Injury Associated with Failure of Lactation

Tomarelli¹,

Arriagada²,

Donoso³

et al. 2019

J Pediatr Intensive Care

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Hypoalimentation is an important cause of hypernatremic dehydration in neonates; however, extreme values of plasma sodium make it necessary to investigate the differential diagnosis. We report the case of a 20-day-old newborn who was admitted with severe hypernatremic dehydration, with plasma sodium of 213 mEq/L and oliguric acute renal failure. The patient was treated with intravenous fluids for correction of dehydration and peritoneal dialysis for adequate sodium correction. During the etiological study, a 10-fold increase in the concentration of sodium in breast milk was detected. Peritoneal dialysis was an effective therapy in the management of the extreme hypernatremia with sodium correction within the recommended rate. At the 1-year follow-up appointment, the child had normal renal function, normal for age psychomotor development, and neurological physical was unremarkable. In conclusion, we report a case of an unusual extreme hypernatremia with discussion of the underlying pathophysiology and, more importantly, the effective treatment with a mixed approach with intravenous fluids and peritoneal dialysis.

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“…Its efficiency is affected by hemodynamics, volume status, and peritoneal membrane permeability, which may change over time in critically ill patients. In fact, PD itself has been implicated as the cause of hypernatremia [4]. Continuous renal replacement therapy (CRRT), either as continuous arteriovenous hemodiafiltration (CAVHD) or continuous venovenous hemodiafiltration (CVVHD), is an alternative form of dialysis therapy for hemodynamically unstable patients.…”

Section: Introductionmentioning

confidence: 99%

Continuous venovenous hemodiafiltration in hypernatremic hyperglycemic nonketotic coma

Lin

McKenney

Price

et al. 2002

Pediatric Nephrology

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Rapid changes in serum sodium concentration can result in adverse neurological outcome. The gradual correction of hypernatremia in the setting of acute renal failure can be difficult to achieve. We describe an obese female teenager who presented with severe hypernatremia, hyperosmolar hyperglycemic nonketotic coma, acute renal failure, and rhabdomyolysis. Her hypernatremia and other serum chemistries were gradually corrected by repeatedly adjusting the dialysate electrolyte composition used during continuous venovenous hemodiafiltration. She had a full recovery of her renal function. She does not have clinical neurological sequelae from hypernatremia during a 1-year follow-up period.

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Acute peritoneal dialysis as both cause and treatment of hypernatremia in an infant

Cited by 19 publications

References 15 publications

Acute Peritoneal Dialysis in Neonates with Acute Kidney Injury and Hypernatremic Dehydration

Acute Peritoneal Dialysis in Neonates with Acute Kidney Injury and Hypernatremic Dehydration

Extreme Neonatal Hypernatremia and Acute Kidney Injury Associated with Failure of Lactation

Continuous venovenous hemodiafiltration in hypernatremic hyperglycemic nonketotic coma

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