A Proposed Approach to the Dialysis Prescription in Severely Hyponatremic Patients with End-Stage Renal Disease

Patients with renal failure and severe hyponatremia present a therapeutic dilemma. Conventional hemodialysis is necessary to correct blood chemistries and volume overload, yet it may raise serum sodium (Na) too quickly, potentially resulting in osmotic demyelination syndrome. We present the case of a patient who presented with renal failure requiring dialysis and also with a serum Na of 112 mEq/l. Using a dialysate Na concentration of 130 mEq/l and by limiting the blood flow to 50 ml/minute, we were able to raise her serum Na by only 2 mEq/l/hour during her hemodialysis treatment and thus control both the rate and total change in the patients serum Na.