title: Correction of hyper- and hyponatraemia during continuous renal replacement therapy.
abstract: BACKGROUND
  Severe hyper- and hyponatraemia is associated with significant risks, yet its correction can also have serious consequences when implemented too fast or inadequately. The safe correction of serum sodium levels is particularly challenging when renal replacement therapy (RRT) is required.
  
  
  METHODS
  Using 2 case scenarios, we aim to illustrate a simple method of correcting hyper- and hyponatraemia safely by step-wise manipulation of the dialysate/replacement fluid.
  
  
  RESULTS
  During continuous RRT, hypernatraemia can be corrected effectively and safely by adding small pre-calculated amounts of 30% NaCl to the dialysate/replacement fluid bags aiming for a [Na(+)] in the fluid that allows safe equilibration and correction of the serum [Na(+)]. To correct hyponatraemia safely, pre-calculated amounts of sterile water can be added in a step-wise manner to achieve a fluid [Na(+)] that equals the desired target serum [Na(+)].
  
  
  CONCLUSIONS
  During continuous RRT, the step-wise adjustment of [Na(+)] of dialysate/replacement fluids offers a safe and reliable method to correct sodium disorders.
authors.affiliation: Department of Critical Care, Guy's & St. Thomas' NHS Foundation Hospital Trust, London, UK.
authors.forename: Carole
authors.initials: C
authors.lastname: Dangoisse
authors.forename: Helen
authors.initials: H
authors.lastname: Dickie
authors.forename: Linda
authors.initials: L
authors.lastname: Tovey
authors.forename: Marlies
authors.initials: M
authors.lastname: Ostermann
mesh_terms: D000328:Adult; D015314:Dialysis Solutions / Q000737:chemistry*; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000628:therapy*; D007010:Hyponatremia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy; D012964:Sodium / Q000097:blood; D014883:Water-Electrolyte Imbalance
chemical_list: D015314:Dialysis Solutions; D012964:Sodium