Case studies in RRT(www.pcrrt.com)

Timothy E Bunchman MDProfessor & DirectorPediatric Nephrology

tbunchman@mcvh-vcu.edupcrrt@aol.com

Case 1

• 15 yo 71 kg female with new onset IDDM, has oliguric AKI with pulmonary edema and hyperkalemia

• She is intubated with a FIO2 of 70% and a peep of 10

• Her labs are concerning

Labs Case 1

• K of 6.3 meq/dl, Na of 175 meq/dl, BUN of 90 mg/dl and a glucose of 1300 mg/dl

• Urine out put is diuretic non responsive and inadequate

• She needs RRT but how• What are her risk factors?

Risk Factors case 1

• Hyperkalemia and pulmonary edema ? (ARDs)• What is her measured osmoles• Osmolarity formula is – 2 x Na + BUN/2.8 and Glucose/18

• She is measured at 488 mmol/l– (Na noted is uncorrected)

• What is the osmolarity of HD, PD or CRRT solutions?

• Which form of RRT is most or least efficient?

Osmols and efficiency

• Osmols of RRT modalities– HD ~ 285– PD ~ 290-340– CRRT (convective and diffusive) ~ 285

• Efficiency– HD 30-50 liters/hr– PD 0.5-2liters/hr– CRRT 0.1 – 8 liters/hr

Changing the Osmols of the Dialysate with 3% NS

260

310

360

410

460

0 12 24 36 48 72 96 120

134

Patient Osmols

Dialysate Osmols

Resources

• Websites/emails• www.pcrrt.com• www.extrip.org• tbunchman@mcvh-

vcu.edu• pcrrt@aol.com