Department of Critical Care Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Department of Nursing, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Nurs Crit Care. 2024 Nov;29(6):1450-1459. doi: 10.1111/nicc.13167. Epub 2024 Sep 22.
Hyponatraemia is a prevalent electrolyte disturbance observed in critically ill patients. The rapid correction of low plasma sodium levels by continuous renal replacement therapy (CRRT) carries the risk of developing osmotic demyelination syndrome (ODS), which can be prevented by implementing an individualized CRRT method.
This study aims to introduce a CRRT protocol for the safe and gradual correction of severe hyponatraemia.
This retrospective case series study was conducted in an intensive care unit (ICU). All four patients with severe hyponatraemia (<125 mmol/L) and renal failure between October 1, 2022, and September 30, 2023, were treated by CRRT with sterile water and regional citrate anticoagulation (RCA). Data on patient demographics, laboratory biochemical parameters, urine outputs and CRRT-related adverse events were collected. Laboratory parameters and urine outputs were compared by paired t-tests before and after CRRT.
After CRRT, sodium levels were significantly increased (112.7 ± 6.7 vs. 141.9 ± 2.8 mmol/L, p = .005). Abnormal urine outputs, potassium, creatinine and bicarbonate were corrected (p for all <.05). Safe and gradual correction of hyponatraemia and internal environmental dysregulation was achieved in all patients without any complications related to CRRT, particularly ODS.
It is a novel and simple strategy to correct severe hyponatraemia effectively while ensuring the safety of patients that can be easily implemented by experienced nurse staff.
The sterile water-based protocol for postfilter dilution is safe to correct severe hyponatraemia with RCA and can be easily performed by experienced critical care nurses according to the precalculated formula. CRRT-trained, experienced ICU nurses are competent to initiate and adjust sterile water infusion discretely to prevent overcorrection of hyponatraemia.
低钠血症是危重症患者中常见的电解质紊乱。连续性肾脏替代治疗（CRRT）快速纠正低血浆钠水平有发展渗透性脱髓鞘综合征（ODS）的风险，通过实施个体化的 CRRT 方法可以预防 ODS 的发生。
本研究旨在介绍一种 CRRT 方案，用于安全逐渐纠正严重低钠血症。
这是一项在重症监护病房（ICU）进行的回顾性病例系列研究。2022 年 10 月 1 日至 2023 年 9 月 30 日期间，4 名严重低钠血症（<125mmol/L）和肾衰竭的患者均接受了 CRRT 治疗，使用无菌水和局部枸橼酸盐抗凝（RCA）。收集患者人口统计学、实验室生化参数、尿量和与 CRRT 相关的不良事件数据。使用配对 t 检验比较 CRRT 前后的实验室参数和尿量。
CRRT 后，钠离子水平显著升高（112.7±6.7 与 141.9±2.8mmol/L，p=0.005）。异常的尿量、钾、肌酐和碳酸氢盐得到纠正（p 均<0.05）。所有患者均未发生与 CRRT 相关的并发症，特别是 ODS，成功安全地逐渐纠正了低钠血症和内环境失调。
该方案采用无菌水基于后稀释的方法，与 RCA 联合使用，在保证患者安全的同时，可有效纠正严重低钠血症，且易于由经验丰富的护士实施。
采用基于无菌水的后稀释方案，与 RCA 联合使用，对接受 RCA 的严重低钠血症患者进行治疗是安全的，并且可以根据预计算的公式由经验丰富的重症监护护士轻松进行。经过 CRRT 培训、经验丰富的 ICU 护士可以胜任启动和调整无菌水输注，以防止低钠血症过度纠正。
