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Treatment of severe hyponatremia in patients with kidney failure: role of continuous venovenous hemofiltration with low-sodium replacement fluid.

American journal of kidney diseases : the official journal of the National Kidney Foundation (2014-05-06)
Lenar Yessayan, Jerry Yee, Stan Frinak, Balazs Szamosfalvi
ABSTRACT

Patients with hypervolemic hyponatremia and kidney failure pose a special therapeutic challenge. Hemodialysis to correct volume overload, azotemia, and abnormal electrolyte levels will result in rapid correction of serum sodium concentration and place the patient at risk for osmotic demyelination syndrome. We present a patient with acute kidney injury and severe hypervolemic hypotonic hyponatremia (serum sodium<100 mEq/L) who was treated successfully with continuous venovenous hemofiltration. This teaching case illustrates the limitations of hemodialysis and demonstrates how to regulate the sodium correction rate by single-pool sodium kinetic modeling during continuous venovenous hemofiltration. Two methods to adjust the replacement fluid to achieve the desired sodium concentration are outlined.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Sodium, ACS reagent, dry
Sigma-Aldrich
Sodium, 99.95% trace metals basis, ingot
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Sodium, 25-35 wt % dispersion in paraffin
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Sodium, in kerosene, pieces (large), ≥99.8% (sodium basis)