Continuous venovenous hemodiafiltration in hypernatremic hyperglycemic nonketotic coma

Abstract

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.

Prognosis in critically ill children requiring continuous renal replacement therapy

“…Currently, the techniques for continuous venovenous renal replacement therapy, allowing continuous fluid removal and with better hemodynamic tolerability, have become the techniques of choice in the treatment of acute renal failure in critically ill patients [1][2][3][4][5][6][7]. These methods are not only used in the treatment of acute renal failure but also in hypervolemia, poisoning, sepsis, multi-organ failure, acute respiratory distress syndrome, and others [1,8].…”

Hyperosmolar solutions in continuous renal replacement therapy for hyperosmolar acute renal failure: A preliminary report*

“…CVVH, continuous venovenous hemofiltration. lysate or FRF solution during RRT allows for a slow decline in plasma osmolality (28,29). In these two reports, osmolality was increased by raising the solution's Na ϩ and/or dextrose concentration or by the administration of intravenous mannitol (28,29).…”

“…lysate or FRF solution during RRT allows for a slow decline in plasma osmolality (28,29). In these two reports, osmolality was increased by raising the solution's Na ϩ and/or dextrose concentration or by the administration of intravenous mannitol (28,29). Rodrigo et al (28) administered either 1 g/kg of intravenous mannitol, raised the glucose concentration of their dialysate to 39.8 mmol/L (717 mg/dL [high glucose]) from 15.2 mmol/L (274 mg/dL [low glucose]), or combined the mannitol with the high-glucose concentration.…”

“…Rodrigo et al (28) reported the use of a hyperosmolar hyperglycemic dialysis solution to slow the rate of decline of plasma osmolality in chronic hemodialysis (HD) patients from 1.7 mOsm/kg/hr (using standard normosmolar dialysis solution) to 0.9 mOsm/kg/hr. More recently, Lin et al (29) reported the use of Objective: To demonstrate the efficacy of hyperosmolar dialysis and prefilter replacement fluid solutions for continuous renal replacement therapies in the correction of hyperosmolar disorders in acute renal failure.…”

The obese child in the Intensive Care Unit. Update

“…In addition, it may appear as hyperglycemic-hyperosmolar state (4%), an uncommon condition that has a significant morbidity and mortality. [67][68][69] …”