title: Treatment of severe hyponatremia in patients with kidney failure: role of continuous venovenous hemofiltration with low-sodium replacement fluid.
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.
authors.affiliation: Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI. Electronic address: lyessay1@hfhs.org.
authors.forename: Lenar
authors.initials: L
authors.lastname: Yessayan
authors.affiliation: Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI.
authors.forename: Jerry
authors.initials: J
authors.lastname: Yee
authors.affiliation: Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI.
authors.forename: Stan
authors.initials: S
authors.lastname: Frinak
authors.affiliation: Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI.
authors.forename: Balazs
authors.initials: B
authors.lastname: Szamosfalvi
mesh_terms: D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007010:Hyponatremia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000379:methods; D012720:Severity of Illness Index; D012964:Sodium / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D012964:Sodium
keywords: Hyponatremia; continuous venovenous hemofiltration (CVVH); hemodialysis; treatment