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Management of severe hyponatremia with low-dose continuous kidney replacement therapy and peripheral D5W in an infant with acute kidney injury
  1. Abby Miriam Basalely1,2,
  2. Minh Dien Duong2,
  3. Diane Liu2 and
  4. Anna Zolotnitskaya2
  1. 1Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, New York, USA
  2. 2Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, New York, USA
  1. Correspondence to Dr Abby Miriam Basalely; abasalely{at}


We report a 7-month-old female infant who presented with anuric acute kidney injury and severe hyponatremia (serum sodium 110 mEq/L). The patient was treated with low-dose continuous kidney replacement therapy (CKRT), that is, 85% of total clearance dose divided equally between normonatric (Na 140 mEq/L) replacement and dialysate fluids. The remaining 15% of the clearance was provided by peripheral infusion of dextrose 5% (D5W). The patient’s sodium was maintained between 119 mEq/L and 121 mEq/L for the first 24 hours of CKRT. Over the next 2 days, the rate of D5W infusion was slowly decreased while replacement and dialysis flow rates were proportionately increased. Serum sodium was normalised by day 2 of the therapy. The patient had no neurologic sequelae associated with this therapy.

  • paediatrics (drugs and medicines)
  • paediatric intensive care
  • acute renal failure
  • dialysis
  • fluid electrolyte and acid-base disturbances

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  • AMB and MDD contributed equally.

  • Contributors AMB, MDD, DL and AZ have substantially contributed to the conception and design of the manuscript and the acquisition and interpretation of the presented data. They have each contributed to drafting the work and critically revising it for important content. Each author has given final approval to the version submitted for publication. Each author is in agreement to all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Abby Basalely and Minh Dien Duong are the co-first authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AB has consulted for Impact Communication Partners.

  • Provenance and peer review Not commissioned; externally peer reviewed.