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Case Reports
. 2015 Nov 29;3(3):260-264.
doi: 10.1002/ams2.170. eCollection 2016 Jul.

Continuous veno-venous hemodialysis and filtration for extensive burn with severe hypernatremia

Kensuke Nakamura  1 , Ryota Inokuchi  2 , Takahiro Hiruma  3 , Takaki Omura  1 , Kazuma Ohshima  1 , Kurato Tokunaga  1 , Atsushi Ueda  4 , Kent Doi  3
Affiliations
Case Reports

Continuous veno-venous hemodialysis and filtration for extensive burn with severe hypernatremia

Kensuke Nakamura et al. Acute Med Surg. .

Abstract

Case: A 51-year-old man presented with severe burns, with a burn index of 33.5. Relaxation incisions were made in the trunk and right arm. Ringer's solution (12,000 mL) was used as initial fluid therapy for the first 24 h. The patient's serum Na level gradually increased to 170 mEq/L; infusion was carried out to correct the hypernatremia. Continuous veno-venous hemodialysis and filtration succeeded in maintaining the serum Na level at approximately 145 mEq/L.

Outcome: After the initiation of continuous veno-venous hemodialysis and filtration, the skin graft survival rate improved markedly with the normalization of the Na level, and the patient recovered smoothly. He was discharged on foot.

Conclusion: Hypernatremia, frequently observed in patients with extensive burns, is considered to be markedly disadvantageous for the survival of skin grafts. Continuous veno-venous hemodialysis and filtration may be one of the options for the treatment of refractory hypernatremia in severe burns.

Keywords: Burn; continuous veno‐venous hemodialysis and filtration; hypernatremia; renal replacement therapy; skin graft.

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Figures

Figure 1
Figure 1
Photographs of a 51‐year‐old man who sustained severe burns, on admission. Grade II and III burns were observed over 35% of the body surface, including the occipital region, left thoracoabdominal region, entire back, left upper extremity, and left buttock. The total burn surface area according to the Lund and Browder chart was 6.0% for grade II and 30.5% for grade III, and the burn index was 33.5.
Figure 2
Figure 2
Clinical course of a 51‐year‐old man who sustained grade II and III burns to over 35% of his body. ABK, arbekacin; CEZ, cefazolin; CPFG, caspofungin; CVVH, continuous veno‐venous hemodialysis and filtration; DRPM, doripenem; LVFX, levofloxacin; PIPC/TAZ, piperacillin/tazobactam; VCM, vancomycin.
Figure 3
Figure 3
Photographs of injury sites 1 year after a 51‐year‐old man sustained grade II and III burns to over 35% of his body. The patient recovered with a little contracture in the left arm.
See this image and copyright information in PMC

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