Custom dialysate solutions

I get nervous when I need to dialyze someone who is severely hyponatremic. Dialysis has the power to change the sodium concentration very fast. Patients with chronic, compensated hyponatremia need their sodium corrected slowly. Experts recommend increasing the sodium by less than 12 mEq/L/day and to actually undertarget only 6 mEq/L/day to give you some margin for error.

Over the week-end we were consulted on a patient with a sodium of 106 and acute renal failure. By the time we were forced to dialyze the patient the sodium was up to 112. To do this safely we selected CVVHD and then diluted our dialysate down to 120 mEq/L.

Here is a Keynote (100 mb), PDF (155 kb) and a narrated version of that presentation (118 mb) where I walk through the algebra on how to mix a dialysate of any final sodium concentration.

The movie available for download is very high quality. Below is a YouTube conversion of that video to save you the 118 mb download.



This is some serious Sodium Jujitsu and I awarded my team the first Nephrology Merit Badge: Sodium Ninja (pages | pdf). Designed for Avery 5163 2x4 labels.

Nephrology Merit Badge, updated for the 21st century as a sticker for your iPad