Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation by Edgar V. Lerma & Mitchell Rosner

Author:Edgar V. Lerma & Mitchell Rosner
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Lithium

Valproic acid

Ethylene glycol

Metformin

Methanol

Theophylline

Isopropanol

Carbamazepine

Ethanol

Barbiturates

Salicylates

Volume Overload

As diuretics are potent activators of the renin–angiotensin–aldosterone system (RAAS), there is strong interest in the use of extracorporeal therapies in the management of cardiorenal syndromes. Heart failure is characterized by combined sodium and water overload, although loop diuretics generate a hypotonic fluid loss. Ultrafiltration removes sodium at an isotonic concentration, thereby avoiding complications of hypernatremia and pharmacologic activation of the RAAS. Although preliminary data support the use of ultrafiltration in the management of cardiorenal syndromes, data from high quality randomized trials demonstrating superiority to the use of diuretics and inotropic agents do not exist [22]. It is reasonable to initiate isolated ultrafiltration (or dialysis if electrolyte abnormalities or uremia coexist) in the management of decompensated heart failure in patients with oliguria. In patients with end-stage liver disease, approximately 1 L of ascites can be mobilized into the plasma space daily [23]. As such, ultrafiltration is more successful at limiting the formation of new ascites than at reducing the volume of existing peritoneal fluid. The use of HD in addition to ultrafiltration is appropriate in the management of hypo- or hypernatremia coexistent with volume overload.

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