Correction of severe hyponatremia by continuous veno-venous hemodialysis with regional citrate anticoagulation: A case series.

INTRODUCTION

Hyponatremia is a common electrolyte disturbance in critically ill patients. Management of intensive care unit patients with concurrent hyponatremia and renal failure requiring dialysis is challenging especially with regional citrate anticoagulation, which may cause excessive rise of serum [Na+ ]. We described the first and successful modified continuous veno-venous hemodialysis (CVVHD) regimen using regional citrate anticoagulation.

METHOD: A mathematical model was developed to predict serum [Na+ ] change during CVVHD. Our in-house CVVHD regimen using regional citrate anticoagulation was modified to slow down the rise of serum [Na+ ] by both modifying the dialysate solution and modifying the circuit.

RESULT: Five out of six patients had gradual serum [Na+ ] correction not exceeding the daily limit. None of them developed osmotic demyelination syndrome.

CONCLUSION

We concluded that regional citrate anticoagulation, with proper modification, is safe and effective for patients with concomitant renal failure requiring hemodialysis.