Continuous veno-venous hemodialysis and filtration for extensive burn with severe hypernatremia

Abstract

Case: A 51-year-old man presented with severe burns, with a burn index of 33.5. Relaxation incisions were made in the trunk and right arm. Ringer's solution (12,000 mL) was used as initial fluid therapy for the first 24 h. The patient's serum Na level gradually increased to 170 mEq/L; infusion was carried out to correct the hypernatremia. Continuous veno-venous hemodialysis and filtration succeeded in maintaining the serum Na level at approximately 145 mEq/L.Outcome: After the initiation of continuous veno-venous hemodialysis and filtration, the skin graft survival rate improved markedly with the normalization of the Na level, and the patient recovered smoothly. He was discharged on foot.Conclusion: Hypernatremia, frequently observed in patients with extensive burns, is considered to be markedly disadvantageous for the survival of skin grafts. Continuous veno-venous hemodialysis and filtration may be one of the options for the treatment of refractory hypernatremia in severe burns.