Đánh giá sự thay đổi điện giải trong lọc máu tĩnh mạch - tĩnh mạch liên tục ở bệnh nhân ngộ độc cấp

Continuous veno-venous hemofiltration (CVVH) is an intensive therapy for the treatment of severe acute poisonings and save many lives, not only by elimination of toxins but also correction of disorders of volume status, acid-base and electrolyte disturbances. However, this therapy may have certain complications ) suchs as hypothermia, infections, electrolyte disturbances, acid-base imbalance. CVVH was indicated in 46 patients with 60 CVVH episodes totally. Gender: male: 26(56.5 ercent), female: 20(43.5 percent). Mean age: 33.6 (14-80) years old. Indication for CVVH: phenobarbital poisoning: 12(26.1 percent), paraquat poisoning: 11(23.9 percent), toxin induced hepatic failure: 7(15.2 percent), Hymenoptera stings: 9(19.6 percent), snakebite: 5(10.9 percent), strong alkali ingestion: 2(4.3 percent). Filtrate fluid: Hemosol was used in 46 episodes (76.7 percent), self-prepared fluid was used in 14 episodes (23.3 percent). Fatality: 15(32.6 percent), survival: 31(67.4 ercent). Electrolyte results before CVVH: hyponatremia: 18/60 (30 percent) episodes, hypernatremia: 5 (8.3 percent), hypokalemia: 27/60 (45 percent), hyperkalemia: 9 (15 percent), hypocalcemia: 26/60 (41.7 percent), only one patient had hypercalcemia (1.7 percent), hypochloremia: 5/60 (8.3 percent), hyperchloremia: 3/60(5 percent). Electrolyte disturbances occurring before CVVH: Sodium: 83.3 percent episodes with hyponatremia before CVVH (lowest level of Na: 123 mEq/l), 80 percent episodes with hypernatremia before CVVH (highest level of Na: 156 mEq/l) were normalized after CVVH. Potassium: 77.8 percent episodes with hypokalemia before CVVH (lowest level of K: 2.1mEq/l), 100 percent episodes with hyperkalemia before CVVH (highest level of K: 6.5mEq/l) were normalized after 6 hour CVVH, however, 44.4 percent of episodes developed hypokalemia after 12 hours (lowest level of K: 3.2 mEq/l). Calcium: 80 percent episodes with hypocalcemia before CVVH (lowest level of Ca: 0.97mmol/l) were normalized after CVVH. Chloride: 100 percent episodes with chloride disturbances before CVVH were normalized after CVVH. Electrolyte disorders occurring during CWH: 5.4 percent episodes had hyponatremia (lowest level of Na: 132 mEq/l), 16.7 percent episodes had hypokalemia (lowest level of K: 3.0mEq/I), 11.8 percent episodes had hypocalcemia after CVVH (lowest level of Ca: 1.78 mmol/I) but not in dangerous range.