A case of severe hyponatremic anuric acute kidney injury safely treated with continuous renal replacement therapy with continuous infusion of dextrose 5％ in water

Abstract

We report a case with acute kidney injury and severe hyponatremia who underwent continuous renal replacement therapy (CRRT). 47 years old woman visited our emergency room for disturbance of consciousness. On admission, she had anuric acute kidney injury and severe hyponatremia (serum sodium concentration of 96mEq/L). Anuria and hyperkalemia did not respond to fluid replacement therapy, and we started CRRT on Day 2. At the initiation of the CRRT, her serum Na was 100mEq/L；CRRT using standard replacement fluid can lead to rapid correction of sodium concentration, which may induce osmotic demyelination syndrome. To avoid rapid correction of hyponatremia while delivering adequate renal replacement therapy, we performed standard post-dilution CRRT methods (replacement fluid rate of 500mL per hour) combined with continuous infusion of 5% glucose solution for 200mL per hour to the Venous chamber. After the 24 hours, her urine flow recovered and we could withdraw CRRT. At the end of the CRRT, her serum Na was 108mEq/L. Her serum sodium concentration was gradually normalized and she could be discharged from the hospital after 22days without sequelae. This dilution method can control the sodium concentration ad libitum by changing the 5％ glucose infusion rate. This CRRT method is effective and convenient for anuric patients presenting severe hyponatremia.