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Báo cáo y học: " Management of sodium disorders during continuous haemofiltration"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Management of sodium disorders during continuous haemofiltration. | Ostermann et al. Critical Care 2010 14 418 http ccforum.eom content 14 3 418 CRITICAL CARE LETTER L_ Management of sodium disorders during continuous haemofiltration Marlies Ostermann Helen Dickie Linda Tovey and David Treacher Abstract In patients with acute kidney injury and concomitant severe hyponatraemia or hypernatraemia rapid correction of the serum Na concentration needs to be avoided. The present paper outlines the principles of how to adjust the Na concentration in the replacement fluid during continuous renal replacement therapy to prevent rapid changes of the serum Na concentration. Introduction Continuous venovenous haemofiltration CVVH is an established treatment for patients with acute kidney injury. During CVVH serum electrolyte concentrations tend to equilibrate with their concentrations in the replacement fluid. The rate at which this happens depends on the difference in their concentrations between serum and replacement fluid and on the rate of treatment. Patients presenting with acute kidney injury may have concomitant severe hyponatraemia or hypernatraemia. Over-rapid correction of the serum Na concentration is associated with pontine myelinosis and or cerebral oedema 1 2 . If CVVH is needed the Na concentration in the replacement fluid usually 140 mmol l needs to be adjusted in order to avoid rapid changes of the serum Na concentration. In the present paper we provide some guidance on how to make these adjustments for CVVH. The same principle could be applied for continuous haemodialysis or diafiltration. Acute kidney injury and hypernatraemia Na 155 mmol l Free water hydration is the first-line therapy if possible. If CVVH is necessary the Na concentration of the replacement fluid should be increased by adding concentrated NaCl solution Table 1 . Generally it is not considered safe to lower the serum Na concentration by more than 8 to 10 mmol l over 24 hours especially in the setting of chronic hypernatraemia 1 . Usually a stepwise .