Severe Hypernatremia and Hyperkalemia in AKI Requiring KRT

Ashita Tolwani Speaker The ABC of the CRRT prescriptionPrescribing continuous renal replacement therapy requires an understanding of how modality, blood flow, treatment dose, replacement-fluid delivery, and circuit factors influence therapy delivery. This presentation will provide a practical framework for developing and evaluating a CRRT prescription, including the principles of diffusive and convective clearance, prescribed versus delivered dose, and the impact of replacement-fluid location and treatment interruptions. Clinical examples will highlight common prescribing challenges and demonstrate how CRRT settings can be adjusted to meet changing patient needs while maintaining effective and safe therapy.AnticoagulationEffective anticoagulation is essential to maintain circuit patency, minimize blood loss, and ensure delivery of the prescribed CRRT dose. This presentation will review the principles guiding anticoagulant selection during CRRT, including the relative roles of regional citrate anticoagulation, unfractionated heparin, and alternative agents. Particular emphasis will be placed on balancing circuit longevity with patient safety, recognizing patients at increased risk for bleeding or citrate intolerance, and monitoring for metabolic and anticoagulation-related complications. Dysnatremia and acid-base disordersContinuous renal replacement therapy can be adapted to safely manage severe sodium and acid–base disturbances. This presentation will review a practical approach to modifying the CRRT prescription based on the patient’s serum sodium, acid–base status, and desired rate of correction. Emphasis will be placed on anticipating how CRRT solutions and treatment settings influence biochemical changes and on avoiding overly rapid correction or treatment-related complications. Clinical examples will illustrate key principles for individualized therapy.Severe hypernatremia and hyperkalemia in AKI requiring KRTManaging Patients With Combined Kidney and Liver Failure

Manish Kaushik Speaker

This session will focus on life-threatening electrolyte disturbances in patients with advanced CKD and AKI requiring kidney replacement therapy.

The case involves an elderly patient with CKD G5A3 presenting with altered mental status, severe azotemia, profound hyperkalemia, metabolic acidosis, and extreme hypernatremia. After emergent hemodialysis, the patient developed coma, raising concern for dialysis disequilibrium syndrome and sodium overcorrection.

The expert discussion will address modality selection between intermittent hemodialysis and CRRT, safe potassium control, prevention and management of dialysis disequilibrium syndrome, use of osmotic agents such as mannitol and hypertonic saline, and practical monitoring targets including neurologic status and serum osmolality.