Biography
Biography: Loai A Eid
Abstract
Introduction: Management of AKI and hyperosmolality using conventional renal replacement methods places patient at higher risk of rapid osmolar shifting that leads to major neurological consequences. CRRT provides the ability to control rate of reduction in osmolality by allowing the adjustment of dialysate solution and narrowing osmolar gap between the patient and dialysate. Further, inefficient solute clearance will less the rate of pH and osmolar changes over time.
Case Presentation: A 16-kg male child with known case of Central Diabetes Insipidus presented unconscious and anuric with septic shock, anemic (Hb 4.8 g/l), AKI (BUN 427 mg/dl, Creatinine 7.6 mg/dl), severe hypernatremia (Na 216 mmol/l), and a PH of 7.0. Measured osmolality was 593 osmols/l. Patient was resuscitated, incubated and shifted to PICU. Inefficient CVVHD using PrismaSate® was begun at 8 mls/kg/hr with an additional 80 meq/l of NaCl to give total Na of 220 meq/L, resulting in a dialysate bath of 550 osmols/l. Patient osmols were recalculated at 3 hours increments and additional Na in the dialysate was decreased as needed.
Results: Based upon patient osmolar changes, additional sodium was adjusted until normal osmols were obtained. Over 72 hours the child had gradual drop of sodium till reaching 170 mmol/l then CVVHD was stopped and patient was shifted to medical treatment of hypernatremia. Over time, patient had recovery of osmols, PH, renal and neurological function and continued on medical management.