Preparation of sodium concentration of dialysate/replacement solution for CRRT in critically ill patients with severe disturbance of sodium concentration

Abstract

Background: CRRT is widely performed for removing pathogenic substances and assisting organ functions in the emergency room and the intensive care unit. However, attention must be given to a possible rapid change in electrolyte concentration due to the removal of useful electrolytes by CRRT. It is known that adverse events such as central pontine myelinolysis and cerebral edema occur with rapid correction of Na concentration by CRRT in patients with severe Na concentration abnormalities including hyponatremia and hypernatremia. Gradual correction of blood Na concentration within 12 mEq/L/day (0.5 mEq/L/hr) is generally recommended. Methods : Since the commercially available dialysate/replacement solution has a Na concentration of 140 mEq/L, a rapid change in Na concentration may occur when used in severe cases of Na concentration abnormality. We inject 5% glucose for hyponatremia and 10% NaCl for hypernatremia into the dialysate/replacement solution to adjust the Na concentration of the solution according to the blood Na concentration. Electrolyte concentration of the dialysate/replacement solution after preparation was confirmed by measurement with a blood gas analyzer before use. Results: CRRT using the dialysate/replacement solution prepared for Na concentration has so far been performed in 10 patients (5 patients with hypernatremia and 5 patients with hyponatremia). Since the change in Na concentration after 24 hours was suppressed within 12 mEq/L, CRRT could be safely performed. Conclusion: Adjustment of the Na concentration in dialysate/replacement solution is considered to be useful for safe CRRT in patients with abnormal Na concentrations.