Ayesha Mukhtar, MD, MPH
Data Analyst III
Emory University Hospital, United States
Disclosure information not submitted.
Alley Killian, BCCCP, PharmD
Clinical Pharmacist, Surgical / Transplant ICU
Emory University Hospital
Atlanta, Georgia
Disclosure information not submitted.
Jolie Gallagher, PharmD, BCCCP
Critical Care Pharmacist
Northside Hospital Gwinnett, United States
Disclosure information not submitted.
Title: Evaluation of Hypertonic Saline in Patients with Acute Liver Failure
Introduction: Acute liver failure (ALF) is a life-threatening illness characterized by rapid deterioration of liver function without pre-existing liver insult. Cerebral edema is the most serious ALF complication and accounts for 80% of all deaths. Hypertonic saline is recommended for the management of cerebral edema. Additionally, extracorporeal liver support systems (MARS) and/or continuous renal replacement therapies (CRRT) can be utilized to maintain homeostatsis. Unfortunately, the addition of MARS/CRRT may impede attainment of a hypernatremic state because dialysate and replacement fluids have a sodium concentration of 140 mEq/L, which is lower than our goal of 145 to 155 mEq/L. Thus, the purpose of this study is to determine if the addition of a 3% sodium chloride (NaCl) infusion improves target attainment of hypernatremic levels in patients on MARS/CRRT.
Methods: A retrospective chart review of medical records from January 1, 2014 to September 30, 2018 was performed on patients that received MARS/CRRT and concurrent 23.4% NaCl in the surgical intensive care unit (ICU) at Emory University Hospital. Patients were excluded if they were missing ≥2 daily nephrology notes specifying flow rates, received MARS/CRRT for ≤24 hours, received 23.4% NaCl for any non-ALF indication, or died within 24 hours of admission to ICU. The primary endpoint was the percent of time arterial blood gas (ABG) sodium levels were 145 to 155 mEq/L. Secondary endpoints included duration of MARS/CRRT, length of stay in the hospital and ICU, time to first ABG sodium within goal range, percentage of sodium levels >155 mEq/L, and the number of 23.4% NaCl boluses administered.
Results: A total of 27 patients were included in this analysis (15 in the bolus treatment group, 12 in the combination treatment group). Combination patients had a higher percentage of time within goal range compared with the bolus treatment, 49% versus 57% (p < 0.001). Patients had similar lengths of stay in the hospital and ICU, durations of CRRT, MARS therapy, and time on acute hepatic failure cerebral edema protocol.
Conclusions: Acute liver failure patients on CRRT/MARS therapy had a higher percentage of time within goal sodium range and trended toward a decreased mortality with the addition of a 3% sodium chloride continuous infusion to 23.4% sodium chloride boluses.