Case studies in RRT (www.pcrrt.com) Timothy E Bunchman MD Professor & Director Pediatric Nephrology tbunchman@mcvh-vcu.edu pcrrt@aol.com.

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Presentation transcript:

Case studies in RRT (www.pcrrt.com) Timothy E Bunchman MD Professor & Director Pediatric Nephrology tbunchman@mcvh-vcu.edu pcrrt@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 Efficiency 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

Resources Websites/emails www.pcrrt.com www.extrip.org tbunchman@mcvh-vcu.edu pcrrt@aol.com