Severe hyponatremia- Is rapid correction safe?

In view of the continuous controversy about the treatment of hyponatremia [rapid or slow correction], we retrospectively studied 40 patients with severe hyponatremia [serum sodium level of 120 mmol/L and less]. Thirteen cases were acute, the remainder [27] were chronic. The mean rate of correction calculated from the rise of serum sodium over the initial 12 hours in both acute and chronic patients, and over the initial 24 hours in the acute and in the majority of the chronic patients was consistent with the definition of rapid correction [increase of serum sodium of >/= 0.5 mmol/L/hr]. Six of the acute and three of the chronic patients died during follow-up of six months. All deaths were caused by the underlying diseases or by complications not related to the hyponatremia or its treatment. None of the patients [alive or deceased] developed any clinical features of central pontine and extrapontine myelinolysis [CPM]. In some of the studies of rapid correction of hyponatremia, chronic alcoholism was felt to be one of the risk factors in the development of CPM. As our patient population, due to religious reasons, abstained from alcohol intake, our results would suggest that in the absence of chronic alcoholism and its attendant malnutrition, rapid correction of severe hyponatremia is probably safe

Chronic intermittent peritoneal dialysis using automatic cycler machine

Although there are many hemodialysis centers in Saudi Arabia, only a few chronic peritoneal dialysis. We describe our findings from a 7-year study of 28 patients with end-stage renal disease who were maintained on chronic intermittent peritoneal dialysis [CIPD] using automatic cycler machines located at Al Hada Armed Forces Hospital, Taif. The duration of dialysis ranged from 4 to 60 months and the age the patients ranged from 6 to 74 years. The incidencations for choosing peritoneal dialysis rather than hemodialysis included severe cardiovascular disease, cerebral hemorrhage, retinal hemorrhage, and lack of vascular access. The technique. Complications, and outcome of patients were evaluated. The incidence of culture-positive peritonitis was at 0.48 episodes per patients year. Seven patients remain on CIPD, five have undergone kidney transplants, kidney function improved in two, three were transferred to other hospital, two were switched oluntarily to hemodialysis, and nine died. Patients with end-stage renal disease who have severe cardiovascular disease and those with poor vascular access should be offered the alternative of peritoneal dialysis. If chronic ambulatory peritoneal dialysis or chronic cyclic peritoneal dialysis is not feasible, the CIPD as described can be adopted easily in most nephrology units

Recurrent hydrothorax in chronic intermittent peritoneal dialysis: successful treatment with intrapleural tetracycline

Recurrent Hydrothorax complicating peritoneal dialysis has been considered a major limiting factor for continuing peritoneal dialysis. In few instances this problem required a change in the dialytic modality. Such a change may not be acceptable to patients. We report here the successful treatment of recurrent hydrothorax with intrapleural tetracycline instillation in a blind patient who is being maintained for two years on chronic intermittent peritoneal dialysis [CIPD] One similar case has been reported, in a patient who was maintained on continuous ambulatory peritoneal dialysis [CAPD]

Severe haemolytic uraemic syndrome: report of a child treated with fresh frozen plasma infusions and dialysis

The incidence and clinical spectrum of haemolytic uraemic syndrome in Saudi Arabia are unknown. In this article we describe a patient with haemolytic uraemic syndrome who was treated with conservative therapy consisting of peritoneal dialysis and plasma infusions. The role of fresh frozen plasma infusion therapy in the management of haemolytic uraemic syndrome is discussed