1. Case studies in RRT (www.pcrrt.com)
Timothy E Bunchman MD
Professor & Director
Pediatric Nephrology

2. 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

3. 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?

4. 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?

5. Osmols and efficiency Osmols of RRT modalities Efficiency HD ~ 285
PD ~
CRRT (convective and diffusive) ~ 285
Efficiency
HD liters/hr
PD 0.5-2liters/hr
CRRT 0.1 – 8 liters/hr

6. Changing the Osmols of the Dialysate with 3% NS

7. Resources Websites/emails www.pcrrt.com www.extrip.org