Safely correct hyponatremia with continuous renal replacement therapy: A flexible, all‐purpose method based on the mixing paradigm
Abstract Treating chronic hyponatremia by continuous renal replacement therapy (CRRT) is challenging because the gradient between a replacement fluid's [sodium] and a patient's serum sodium can be steep, risking too rapid of a correction rate with possible consequences. Besides CRRT, other...
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Physiological Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.14814/phy2.15496 |
| _version_ | 1797397068637011968 |
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| author | Sheldon Chen Jerry Yee Robert Chiaramonte |
| author_facet | Sheldon Chen Jerry Yee Robert Chiaramonte |
| author_sort | Sheldon Chen |
| collection | DOAJ |
| description | Abstract Treating chronic hyponatremia by continuous renal replacement therapy (CRRT) is challenging because the gradient between a replacement fluid's [sodium] and a patient's serum sodium can be steep, risking too rapid of a correction rate with possible consequences. Besides CRRT, other gains and losses of sodium‐ and potassium‐containing solutions, like intravenous fluid and urine output, affect the correction of serum sodium over time, known as osmotherapy. The way these fluids interact and contribute to the sodium/potassium/water balance can be parsed as a mixing problem. As Na/K/H2O are added, mixed in the body, and drained via CRRT, the net balance of solutes must be related to the change in serum sodium, expressible as a differential equation. Its solution has many variables, one of which is the sodium correction rate, but all variables can be evaluated by a root‐finding technique. The mixing paradigm is proved to replicate the established equations of osmotherapy, as in the special case of a steady volume. The flexibility to solve for any variable broadens our treatment options. If the pre‐filter replacement fluid cannot be diluted, then we can compensate by calculating the CRRT blood flow rate needed. Or we can deduce the infusion rate of dextrose 5% water, post‐filter, to appropriately slow the rise in serum sodium. In conclusion, the mixing model is a generalizable and practical tool to analyze patient scenarios of greater complexity than before, to help doctors customize a CRRT prescription to safely and effectively reach the serum sodium target. |
| first_indexed | 2024-03-09T01:05:37Z |
| format | Article |
| id | doaj.art-57fc2ca69ec54fb1b1f7e8ff07655411 |
| institution | Directory Open Access Journal |
| issn | 2051-817X |
| language | English |
| last_indexed | 2024-03-09T01:05:37Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Physiological Reports |
| spelling | doaj.art-57fc2ca69ec54fb1b1f7e8ff076554112023-12-11T10:10:45ZengWileyPhysiological Reports2051-817X2023-01-01111n/an/a10.14814/phy2.15496Safely correct hyponatremia with continuous renal replacement therapy: A flexible, all‐purpose method based on the mixing paradigmSheldon Chen0Jerry Yee1Robert Chiaramonte2Section of Nephrology MD Anderson Cancer Center Houston Texas USADivision of Nephrology and Hypertension Henry Ford Hospital Detroit Michigan USAInternal Medicine SUNY Downstate New York New York USAAbstract Treating chronic hyponatremia by continuous renal replacement therapy (CRRT) is challenging because the gradient between a replacement fluid's [sodium] and a patient's serum sodium can be steep, risking too rapid of a correction rate with possible consequences. Besides CRRT, other gains and losses of sodium‐ and potassium‐containing solutions, like intravenous fluid and urine output, affect the correction of serum sodium over time, known as osmotherapy. The way these fluids interact and contribute to the sodium/potassium/water balance can be parsed as a mixing problem. As Na/K/H2O are added, mixed in the body, and drained via CRRT, the net balance of solutes must be related to the change in serum sodium, expressible as a differential equation. Its solution has many variables, one of which is the sodium correction rate, but all variables can be evaluated by a root‐finding technique. The mixing paradigm is proved to replicate the established equations of osmotherapy, as in the special case of a steady volume. The flexibility to solve for any variable broadens our treatment options. If the pre‐filter replacement fluid cannot be diluted, then we can compensate by calculating the CRRT blood flow rate needed. Or we can deduce the infusion rate of dextrose 5% water, post‐filter, to appropriately slow the rise in serum sodium. In conclusion, the mixing model is a generalizable and practical tool to analyze patient scenarios of greater complexity than before, to help doctors customize a CRRT prescription to safely and effectively reach the serum sodium target.https://doi.org/10.14814/phy2.15496CRRThemofiltrationkineticsmathematical models |
| spellingShingle | Sheldon Chen Jerry Yee Robert Chiaramonte Safely correct hyponatremia with continuous renal replacement therapy: A flexible, all‐purpose method based on the mixing paradigm Physiological Reports CRRT hemofiltration kinetics mathematical models |
| title | Safely correct hyponatremia with continuous renal replacement therapy: A flexible, all‐purpose method based on the mixing paradigm |
| title_full | Safely correct hyponatremia with continuous renal replacement therapy: A flexible, all‐purpose method based on the mixing paradigm |
| title_fullStr | Safely correct hyponatremia with continuous renal replacement therapy: A flexible, all‐purpose method based on the mixing paradigm |
| title_full_unstemmed | Safely correct hyponatremia with continuous renal replacement therapy: A flexible, all‐purpose method based on the mixing paradigm |
| title_short | Safely correct hyponatremia with continuous renal replacement therapy: A flexible, all‐purpose method based on the mixing paradigm |
| title_sort | safely correct hyponatremia with continuous renal replacement therapy a flexible all purpose method based on the mixing paradigm |
| topic | CRRT hemofiltration kinetics mathematical models |
| url | https://doi.org/10.14814/phy2.15496 |
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