Giabicani Mikhael, Guitard Pierre-Gildas, Guerrot Dominique, Grangé Steven, Teule Lauranne, Dureuil Bertrand, Veber Benoît
Pôle réanimation-anesthésie-Samu, réanimation chirurgicale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France.
Pôle réanimation-anesthésie-Samu, réanimation chirurgicale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France.
Nephrol Ther. 2015 Nov;11(6):492-5. doi: 10.1016/j.nephro.2015.04.004. Epub 2015 Jul 11.
Extreme hypernatremia in intensive care unit are frequently associated with a poor prognosis and their treatment, when associated with acute renal failure, is not consensual. We report the case of a 39-year-old man admitted in our intensive care unit for coma who presented extreme hyperosmolar hypernatremia (sodium 180 mmol/L, osmolarity 507 mOsm/L) associated with acute renal failure (urea 139.3 mmol/L, creatinine 748 μmol/L) and many other metabolic abnormalities. He was treated with hypotonic fluid administration and continuous renal replacement therapy (veno-venous hemodiafiltration) using an industrial dialysate fluid. Natremia was controlled by modulating intravenous water and sodium intake according to biological data. After 10 days, continuous renal replacement therapy was stopped and neurological exam was normal. Continuous veno-venous hemodiafiltration may be useful for treatment of extreme hypernatremia by allowing gradual correction of fluid and electrolyte disorders.
重症监护病房中的严重高钠血症常与预后不良相关，而且当它与急性肾衰竭相关时，其治疗方法尚无共识。我们报告了一名39岁男性患者的病例，该患者因昏迷入住我们的重症监护病房，表现为严重高渗性高钠血症（血钠180 mmol/L，渗透压507 mOsm/L），同时伴有急性肾衰竭（尿素139.3 mmol/L，肌酐748 μmol/L）以及许多其他代谢异常。他接受了低渗液体输注治疗，并使用工业透析液进行持续肾脏替代治疗（静脉-静脉血液透析滤过）。根据生物学数据调节静脉水和钠的摄入量来控制血钠水平。10天后，停止持续肾脏替代治疗，神经系统检查正常。持续静脉-静脉血液透析滤过通过逐步纠正液体和电解质紊乱，可能对治疗严重高钠血症有用。
Zotero 插件