title: Hyperosmolar solutions in continuous renal replacement therapy for hyperosmolar acute renal failure: a preliminary report.
abstract: 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.
  
  
  METHODS
  An Institutional Review Board-approved pediatric acute renal failure database at the University of Michigan C. S. Mott Children's Hospital.
  
  
  METHODS
  Three patients were identified meeting the inclusion criteria. The mean serum sodium concentration and plasma osmolality were 158 mmol/L and 357 mOsm/kg, respectively, at the time of initiation of renal replacement therapy. The sodium and/or dextrose concentrations of the dialysate or replacement fluids initially were increased and subsequently decreased to affect the solutions' calculated osmolalities in an effort to control the rate of decline of the patients' measured plasma osmolalities.
  
  
  METHODS
  The case patients' serum sodium concentrations and plasma osmolalities were measured. Additionally, the sodium and dextrose concentrations of the dialysate or replacement fluid were recorded and the solutions' osmolalities calculated.
  
  
  RESULTS
  The three patients experienced a mean rate of reduction of their serum sodium concentration and plasma osmolality of 0.5 mmol/L/hr and 1.6 mOsm/kg/hr, respectively.
  
  
  CONCLUSIONS
  Hyperosmolar dialysis or prefilter replacement fluid solutions can affect a slow decline in both the serum sodium and plasma osmolality in cases of hyperosmolar acute renal failure.
authors.affiliation: Department of Pediatrics, Children's National Medical Center, The George Washington University, Washington, DC, USA.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: McBryde
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Bunchman
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Kudelka
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Pasko
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Brophy
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000293:Adolescent; D015312:Hemodialysis Solutions / Q000737:chemistry* / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009994:Osmolar Concentration; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D015312:Hemodialysis Solutions