Meet the Expert 3

Severe Hypernatremia and Hyperkalemia in AKI Requiring Kidney Replacement Therapy

Session Overview

The simultaneous presence of severe hypernatremia, hyperkalemia, metabolic acidosis, and advanced kidney dysfunction creates major therapeutic challenges. Rapid correction may be lifesaving, but overly aggressive changes in potassium, sodium, urea, or serum osmolality can result in serious neurologic complications.

Using a case of an elderly patient with CKD G5A3 who presented with altered mental status, severe azotemia, profound hyperkalemia, metabolic acidosis, and extreme hypernatremia, this session will examine the selection and prescription of kidney replacement therapy (KRT) in patients with multiple competing electrolyte and osmotic priorities. The patient’s subsequent coma after emergent hemodialysis will provide a framework for discussing dialysis disequilibrium syndrome and excessive osmotic shifts.

What Will Be Covered

• Initial prioritization of hyperkalemia, hypernatremia, acidosis, and severe azotemia
• Selection between intermittent hemodialysis and continuous renal replacement therapy (CRRT)
• Strategies for rapid but controlled potassium removal
• Individualization of dialysate and replacement-fluid sodium concentrations
• Prevention, recognition, and management of dialysis disequilibrium syndrome
• Use of mannitol, hypertonic saline, and other measures to control osmotic shifts
• Monitoring of neurologic status, serum sodium, urea, osmolality, and osmolar changes
• Adjustment of KRT prescriptions according to the evolving clinical response

What Participants Will Learn

Participants will learn how to balance the competing goals of urgent potassium removal, controlled sodium correction, and gradual reduction of severe azotemia. They will also learn how to select an appropriate KRT modality and design a prescription that minimizes rapid changes in plasma tonicity and cerebral water balance.

Target Audience

Nephrologists, intensivists, emergency physicians, internists, fellows, residents, dialysis nurses, and other healthcare professionals involved in the management of severe electrolyte disturbances and acute kidney injury.

如何在AKI合併嚴重高血鈉與高血鉀時開立透析

課程簡介

當嚴重高血鉀、高血鈉、代謝性酸中毒與嚴重氮血症同時出現時，治療往往面臨相互衝突的目標：一方面必須迅速降低 potassium，以避免致命性心律不整；另一方面又必須控制 sodium、urea 與 serum osmolality 的變化速度，以降低腦水腫及其他神經學併發症的風險。

本場次將以一名 CKD G5A3 高齡病人為例。病人因意識改變就醫，檢查發現 severe azotemia、profound hyperkalemia、metabolic acidosis 與 extreme hypernatremia。病人在接受緊急 hemodialysis 後陷入昏迷，需進一步鑑別 dialysis disequilibrium syndrome、過快的 sodium correction，以及其他可能造成意識惡化的原因。

課程內容

• Severe hyperkalemia、hypernatremia、acidosis 與 azotemia 的治療優先順序
• Intermittent hemodialysis 與 CRRT 的選擇
• 如何快速而安全地移除 potassium
• Dialysate sodium 與 replacement fluid sodium 的個別化調整
• Dialysis disequilibrium syndrome 的預防、辨識與處置
• Mannitol、hypertonic saline 及其他控制 osmotic shift 的治療策略
• Neurologic status、serum sodium、urea 與 serum osmolality 的監測
• 如何依據治療反應即時調整 KRT prescription

參與者將學到

參與者將學習如何在「緊急降鉀」、「控制 sodium correction」與「避免 urea 下降過快」之間取得平衡，並根據血流動力學、神經學狀態及滲透壓變化風險選擇適當的 KRT modality。

課程亦將說明如何設計個別化 dialysis prescription，以降低 plasma tonicity 快速變化及 cerebral edema 的風險。

適合對象

腎臟科、重症醫學科、急診醫學科及一般內科醫師，以及參與嚴重電解質異常、急性腎損傷與急重症透析照護的住院醫師、研究醫師、透析護理師及其他醫療專業人員。