Critically Ill, Hypernatremia
Conditions
Keywords
continuous venovenous hemofiltration, conventional treatment, mortality, acute severe hypernatremia
Brief summary
The patients with severe hypernatremia who received conventional treatment are often undertreated. Continuous venovenous hemofiltration (CVVH) can effectively remove solute or water from circulation system. Several case reports demonstrated that CVVH could effectively decrease serum sodium concentration of the patients with severe hypernatremia. The use of CVVH for acute severe hypernatremia in critically ill patients could improve patient survival by effectively decreasing the serum sodium concentration to a normal level.
Detailed description
Date collection: 1. Demographic (gender, age, race, weight, history of drug allergy, complicating diseases, drug combination and combination therapy) 2. CVVH treatment (time, blood vessel, blood flow, replacement fluid flow, the type and dose of anticoagulant, limited to the test group) 3. Vital signs (blood pressure, heart rate, respiratory frequency, body temperature) 4. Severity of disease 5. General treatment (Vasoactive drugs, mechanical ventilation, diuretic, steroid hormones) 6.24 hours input 7.24 hour output 8.Daily sodium intake 9.Adverse events were confirmed 10.Laboratory date: Routine blood test Blood biochemical Blood gas analysis Blood electrolyte Plasma osmotic pressure Urine osmotic pressure Plasma osmotic pressure Urinary electrolyte excretion fraction
Interventions
PROCEDUREcontinuous venovenous hemofiltration
If the serum sodium concentration \>150mmol/L, When filter occurred clotting, replace the filter to CVVH treatment
DRUGControl group
If the serum sodium concentration ≤150mmol/L, When filter occurred clotting, as the end of treatment.
Sponsors
Air Force Military Medical University, China
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age≥18 years 2. Acute severe hypernatremia(increasing of serum sodium levels from normal levels to ≥160 mmol/L within 48 hours) 3. ICU patients
Exclusion criteria
1. Hypovolemic hypernatremia fractional excretion of sodium \<0.5% and Urea/Creatinine \>40 receiving diuretics: Urea/Creatinine \>40, No edema. 2. Acute kidney injure network III 3. End-stage renal disease Hemodialysis or peritoneal dialysis 4. K+\>6.5mmol/L The drug is difficult to treat hyperkalemia 5. Hydrogen ion concentration\<7.2 The drug is difficult to treat metabolic acidosis 6. Acute pulmonary edema 7. Systolic blood pressure \<90 mmHg vasoactive drugs in the treatment of systolic blood pressure less than 90 mmHg 8. The heparin or low molecular allergic patients 9. HIV positive patients 10. Pregnant women or lactational pregnancy women 11. Suspected tuberculosis patients
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 7-day all cause mortality | 7days |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Glasgow Coma score changes | 3 days | On the third day of the Glasgow Coma score minus baseline of the Glasgow Coma score |
| Sequential Organ Failure Assessment score changes | 3 days | On the third day of the Sequential Organ Failure Assessment score minus baseline of the Sequential Organ Failure Assessment score |
| Acute Physiology and Chronic Health Evaluation II score changes | 3 days | On the third day of the Acute Physiology and Chronic Health Evaluation II score minus baseline of the Acute Physiology and Chronic Health Evaluation II score |
| The average reduce rate of serum sodium | 3 days | The average reduce rate of serum sodium was calculated as following: (serum sodium concentration before treatment (mmol/L) - serum sodium concentration after treatment (mmol/L)) / time after treatment (hours) |
| 24-hour correction of hypernatremia | 24-hour | Twenty-four-hour correction of hypernatremia was defined as the reduction of serum sodium concentration to ≤145 mmol/L within 24 hours after the start of treatment. |
Countries
China
Contacts
Primary ContactShiren Sun, M.D.
Backup ContactFeng Ma, M.D.
Outcome results
None listed