ICU Department, Brugmann University Hospital, Brussels, Belgium,
ICU Department, Brugmann University Hospital, Brussels, Belgium.
Blood Purif. 2021;50(2):174-179. doi: 10.1159/000509024. Epub 2020 Jul 8.
Correcting hyponatremia too quickly can lead to osmotic demyelination syndrome. During citrate dialysis, a significant sodium load is brought to the prefilter. We reviewed the impact of this sodium load on the evolution of sodium levels in patients undergoing continuous renal replacement therapy with citrate anticoagulation.
The medical records of 5 patients with hyponatremia who received dialysis with citrate anticoagulation, over a 10-year period, were reviewed. The sodium of the dialysate and of the reinjection fluid was adapted according to the serum sodium level recommended by the guidelines of the time. Data from the first 24 h after initiation of dialysis was evaluated.
The difference in serum sodium levels between day 1 and day 2 was statistically significant, with a rise of 7.8 ± 3.7 mmol/L.
The mean serum sodium increase in our series of patients did not exceed the increase of 10-12 mEq/L/day permitted by the guidelines. The excess sodium was absorbed by the filter.
In this small series of patients, with adjustment of the sodium concentration of dialysate and reinjection fluid, the use of citrate was found to be safe.
过快纠正低钠血症可导致渗透性脱髓鞘综合征。在柠檬酸盐透析过程中，大量钠离子被带到预滤器中。我们回顾了这种钠离子负荷对接受柠檬酸盐抗凝连续肾脏替代治疗的患者钠离子水平演变的影响。
回顾了在过去 10 年中，5 例接受柠檬酸抗凝透析的低钠血症患者的病历。根据当时指南推荐的血清钠水平，调整透析液和再注入液中的钠含量。评估了透析开始后 24 小时内的数据。
第 1 天和第 2 天血清钠水平的差异具有统计学意义，上升了 7.8±3.7mmol/L。
我们的患者系列中平均血清钠升高未超过指南允许的每天增加 10-12mEq/L。多余的钠被过滤器吸收。
在这组小患者中，通过调整透析液和再注入液中的钠离子浓度，发现使用柠檬酸盐是安全的。
