Patient with Severe Hyponatremia and AKI: A Case Study

Orlando—According to Eddy DeJesus, MD, and colleagues, management of hyponatremia in the setting of acute kidney injury (AKI) is problematic. They presented the case study of a patient with severe hyponatremia in the setting of AKI requiring dialysis during a poster session at the NFK 2017 Spring Clinical Meetings in a poster titled A Case of Severe Hyponatremia and Acute Kidney Injury.

The patient was a 29-year-old woman with a medical history of HIV since birth. She was an active smoker, had a cocaine dependence, and recent urologic instrumentation with stone removal. She presented to the emergency department with generalized weakness, loss of weight, and poor intake for 3 days.

Her serum sodium level was 107 mEq/L; serum potassium was 7.5 mEq/L, serum creatinine level was 9.7 mg/dL, and blood urea nitrogen level was 144 mg/dL. She was hypotensive, with blood pressure 82/31 mmHg. Sinus rhythm was normal on electrocardiography; there were no peaked T waves. The patient’s mental status changed on physical exam.

She underwent catheter placement through the right internal jugular vein and dialysis was initiated with a sodium bath of 130 mEq/L, with a blood flow of 200 mL/min. Blood flow was lowered to 100 mL/min to avoid overcorrections. Serum sodium was checked frequently during dialysis and D5W bolus of 250 mL and 200 mL were given when repeat serum sodium during dialysis was seen to be 123.

Total dialysis duration was 1 hour and 30 minutes. Following dialysis completion, D5W was continued at a rate of 150 mL per hour to lower it to 115 mEq/L, and then gradually increased over 3 or 4 days. The patient was discharged from the hospital with no complications and intact mental status.

In summary, the researchers said, “Acute kidney injury in the setting of severe hyponatremia remains challenging. Nephrologists should remain vigilant to the possibility of osmotic demyelination syndrome, which could develop from overcorrection of hyponatremia during dialysis.”

Source: Eddy D, Rabih N. A case of severe hyponatremia and acute kidney injury. Abstract of a poster presented at the National Kidney Foundation 2017 Spring Clinical Meetings, April 19-22, 2017, Orlando, Florida.