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Case studies in RRT (pcrrt)

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

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Case studies in RRT (pcrrt)

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

  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 • 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

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

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

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