Monitoring and Management of Fluid, Acid-base and Electrolyte in the Critically Ill Patients with Renal Replacement Therapy
Kensuke Nakamura1, Jun Oda2
1Emergency and Critical Care Medicine, Hitachi General Hospital, Japan
2Emergency and Critical Care Medicine, Tokyo Medical University, Japan
In the recent critical care, renal replacement therapy RRT is often introduced to the critically ill patients with acute kidney injury AKI. Uniform early indication or intensive dose of RRT has not been recommended with the evidence, however, RRT, especially continuous renal replacement therapy CRRT, has a numbers of advantages for the management of critical conditions and AKI. Management of fluid, acid-base and electrolyte balance can be done much appropriately with CRRT and it would give the patients a lot of benefits theoretically. To refer to fluid management for AKI, there has been the paradigm shift that not water-rich management, but appropriate setting of water management window to avoid volume overload is very important. Fluid volume monitoring with arterial pressure analysis and transpulmonary thermodilution methods, which can give the information of cardiac output, generalized end-diastolic volume and extravascular lung water, are effective even in CRRT, and fluid management with CRRT would be more appropriate. Severe acidosis negatively affects the circulation and CRRT can contribute to the management of acid-base balance. CRRT also contribute to the management of some electrolytes, such as potassium and sodium, and it would be associated with important and great advantage in the critical care. Meanwhile, it should be taken alert that the other important electrolytes would be lost with CRRT, especially phosphate. Hypophosphatamia possibly induce the muscle loss and ICU acquired weakness. In this presentation, we would like to talk about these advantages and disadvantages of RRT and how to monitor them.