Sodium-reduced continuous venovenous hemodiafiltration (CVVHDF) for the prevention of central pontine myelinolysis (CPM) in hyponatremic patients scheduled for orthotopic liver transplantation.
Two patients in end-stage hepatic failure presented for orthotopic liver transplantation with longstanding severe hyponatremia (121 and 122 mmol/L). Both patients underwent liver transplantation with the concomitant use of continuous venovenous hemodiafiltration. Replacement and dialysate solutions were prepared individually to contain a sodium level that was individually considered safe with regard to the development of central pontine myelinolysis. The sodium increase in both patients was within the expected and planned limits despite a situation of mass transfusion. Both patients did well postoperatively and neither patient suffered neurological deficits.
Klinik für Anästhesiologie, Klinikum der Universität München, Campus Grosshadern, Marchioninistrasse 15, D-81377 München, Germany. marcus.lenk@med.uni-muenchen.de
Marcus R
MR
Lenk
Michael
M
Kaspar
D058625:End Stage Liver Disease / Q000601:surgery; D017583:Hemodiafiltration / Q000379:methods*; D015312:Hemodialysis Solutions / Q000737:chemistry; D006801:Humans; D007010:Hyponatremia / Q000150:complications*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D017590:Myelinolysis, Central Pontine / Q000517:prevention & control*; D012964:Sodium / Q000008:administration & dosage*
D015312:Hemodialysis Solutions; D012964:Sodium