Continuous venovenous hemodialysis

CWH, continuous venovenous hemofiltration CWHD, continuous venovenous hemodialysis CVVHDF, continuous venovenous hemodiafil-tration. 

Beckmann U, Oakley PW, Dawson AH, Byth PL. Efficacy of continuous venovenous hemodialysis in the treatment of severe lithium toxicity. J Toxicol Chn Toxicol 2001 39(4) 393-7. 

A 73-year-old man took an unknown number of theophylline modified-release tablets and furosemide 40 mg tablets. He developed a tachydysrhythmia, vomiting, and restlessness. His maximum theophylline concentration was 67 pg/ml and he had hypokalemia (2.8 mmol/1) and hyponatremia (123 mmol/1). The maximum creatine kinase activity was (32 mol/1 [sic]) and the serum myoglobin concentration was 3789 pg/l. He was treated with oral activated charcoal, continuous venovenous hemodialysis, intravenous potassium and sodium chloride, forced diuresis, and continuous intravenous meto-prolol, and survived without sequelae. 

Matzke GR, Frye RF, Joy MS, Palevsky PM. Determinants of ceftazidime clearance by continuous venovenous hemofiltration and continuous venovenous hemodialysis. Antimicrob Agents Chemother 2000 44 1639— 1644. 

Meier-Kriesche HU, et al. Unexpected severe hypocalcemia during continuous venovenous hemodialysis with regional citrate anticoagulation. Am J Kidney Dis 1999 33 e8. 

Continuous arteriovenous hemodialysis and continuous venovenous hemodialysis can clear 60-85 L per day of lithium [119]. The main advantage of this treatment is that it decreases chances of hthium rebound. The disadvantages pertain to the fact that such continuous therapies do not reduce levels as quickly as hemodialysis and are often limited by the need for anticoagulation. 

A twenty-year-old woman experienced kidney failure after the birth of her baby. She was placed on continuous venovenous hemodialysis, at the time a new and expensive type of dialysis used for critically ill patients from which complications can develop. 

Kanakiriya S, De Chazal I, Nath KA, Haugen EN, Albright RC, Juncos LA. Iodine toxicity treated with hemodialysis and continuous venovenous hemodiafiltration. Am J Kidney Dis 2003 41 702-8. 

The results of hemodialysis in biguanide-induced lactic acidosis are variable. Metformin and buformin are dialy-sable, but phenformin is poorly eliminated. Successful continuous venovenous hemofiltration has been reported (81). 

Hemodialysis (383,552,553), sometimes with additional continuous venovenous hemofiltration dialysis (554,555), continues to be described as a successful intervention for lithium poisoning. Peritoneal dialysis is a far less efficient way to clear lithium from the body. One patient treated in this way had permanent neurological abnormalities and another died a third toxic patient who also had diabetic ketoacidosis died after treatment with hydration and insulin (556). On the other hand, a 51-year-old woman who took 50 slow-release lithium carbonate tablets (450 mg) had a serum lithium concentration of 10.6 mmol/1 13 hours later, but no evidence of neurotoxicity or nephrotoxicity. She was treated conservatively with intravenous fluids and recovered fully (557). Acute lithium overdose is often better tolerated than chronic intoxication. 

Two teenagers with neurological toxicity (serum concentrations 5.4 mmol/1 and 4.81 mmol/1) were treated successfully with hemodialysis followed by continuous venovenous hemofiltration, which prevented a post-dialysis rebound in serum lithium concentrations (554). 

In addition to discontinuation of the NRTT, L-car-nitine, riboflavin, and thiamine have been used in isolated reports but with unclear fherapeutic role [106, 111-113] Many of these patients have been treated with high-dose intravenous sodium bicarbonate. Hemodialysis [114] and continuous venovenous hemodiafiltra-tion [85] have been used to reduce the lactic acidosis, even in the absence of significant kidney injury. Lactic acidosis transiently and modestly improved after administration of dichloroacetate in one report [99]. The benefit of any of these therapies remains unclear. 

In addition to patient-specific differences, there are marked differences between intermittent hemodialysis and the three primary types of CRRT continuous arteriovenous or venovenous hemofiltration (CAVH/CVVH), continuous arteriovenous or venovenous hemodialysis (CAVHD/CVVHD), and continuous arteriovenous or venovenous hemodiaflltration (CAVHDF/CVVHDF) with regard to drug removal." ... 

Metformin is removed by hemodialysis, which can also help correct severe lactic acidosis. Continuous venovenous hemodiafiltration has also been recommended. 

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