Koning Mark V, Reijnen Lassima, Kemperman Femy, Schipper-Reintjes Eugenie
Department of Anesthesiology and Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands.
Department of Nephrology, Rijnstate Hospital, Arnhem, The Netherlands.
Case Rep Nephrol Dial. 2025 Jan 29;15(1):26-32. doi: 10.1159/000543718. eCollection 2025 Jan-Dec.
When a patient with severe hyponatremia requires renal replacement therapy, a too rapid correction of sodium levels may occur. Manual dilution of the fluids during continuous renal replacement therapy (CRRT) is a method that can lead to a controlled correction of sodium. We present a case and add a systematic review to determine the feasibility of this method.
A female was admitted to the intensive care unit with acute kidney failure due to anti-glomerular basement membrane antibody glomerulonephritis, anuria, and an initial sodium level of 100 mmol/L. She received CRRT with manually diluted fluids for 6 days, in which sodium levels increased from 108 mmol/L to 130 mmol/L. A search in Medline, Web of Science, and Google Scholar was added for the systematic review. The search yielded 49 cases, including the current report, of which 47 were anuric or oliguric, in which the fluids were diluted to a median of 8 mmol/L (interquartile range 5-11) (range 0-17) above the serum sodium, the median CRRT dose was 27 mL/kg/h (22-30) (13-77.5). This led to an increase in serum sodium of 0.2 mmol/L/h (0.1-0.3) (0-0.7).
CRRT with manually diluted fluids in patients with severe hyponatremia and anuria can lead to a controlled increase serum sodium, while allowing sufficient RRT dose and fluid removal. Still, errors in dilution may occur and we recommend 4 hourly monitoring of serum sodium levels to timely detect an inadvertent increase in sodium.
当重度低钠血症患者需要肾脏替代治疗时，可能会出现钠水平纠正过快的情况。在持续肾脏替代治疗（CRRT）期间手动稀释液体是一种可实现钠水平可控纠正的方法。我们报告一例病例并进行系统评价，以确定该方法的可行性。
一名女性因抗肾小球基底膜抗体肾小球肾炎导致急性肾衰竭、无尿入院，初始钠水平为100 mmol/L。她接受了为期6天的手动稀释液体的CRRT治疗，在此期间钠水平从108 mmol/L升至130 mmol/L。为进行系统评价，我们检索了Medline、科学网和谷歌学术。检索结果包括本报告在内共49例病例，其中47例为无尿或少尿患者，所使用的液体被稀释至比血清钠水平高8 mmol/L（四分位间距5 - 11）（范围0 - 17），CRRT剂量中位数为27 mL/kg/h（22 - 30）（13 - 77.5）。这使得血清钠水平每小时升高0.2 mmol/L（0.1 - 0.3）（0 - 0.7）。
对于重度低钠血症且无尿的患者，采用手动稀释液体的CRRT可使血清钠水平得到可控升高，同时能保证足够的肾脏替代治疗剂量和液体清除量。不过，仍可能出现稀释错误，我们建议每4小时监测血清钠水平，以便及时发现钠水平的意外升高。
