Hyponatremia

  • Hyponatremia can occur
    • At the start of dialysis if an error is made when connecting concentrate containers
    • During dialysis if containers run dry and conductivity monitor fail1

Treatment

  • Clamp the bloodlines
  • Discard the blood present in the dialysis tubing (as acute hyponatremia during HD is frequently associated with hemolysis and hyperkalemia)
  • Anticonvulsants and blood transfusion may be needed
  • Rapid correction of hyponatremia in HD patients may not be dangerous2,3 (except for one case report4)
  • Current recommendation would be to correct hyponatremia using the guidelines currently accepted for nonuremic patients

Prevention

  • Dialysate sodium level should be higher than that in plasma5

References:

  1. Olivero JJ, Dichoso C. Severe hyponatremia in a home-dialysis patient. JAMA 239:108-109, 1978
  2. Oo TN, Smith CL, Swan SK. Does uremia protect against the demyelination associated with correction of hyponatremia during hemodialysis? A case report and literature review. Semin Dial 1:68-71, 2003
  3. Soupart A, Silver S, Schroeder B, Sterns R, Decaux G. Rapid (24-hour) reaccumulation of brain organic osmolytes (particularly myo-inositol) in azotemic rats after correction of chronic hyponatremia. J Am Soc Nephrol  13:1433-1441, 2002
  4. Peces R, Ablanedo P, Alvarez J. Central pontine and extrapontine myelinolysis following correction of severe hyponatremia. Nephron 49:160-163, 1988
  5. Sterns RH, Silver SM. Hemodialysis in hyponatremia: Is there a risk? Semin Dial 3:3-4, 1990