Treatment of hyperammonemia using in-line renal replacement and hyperosmolar therapies within an extracorporeal membrane oxygenation circuit. (January 2023)

• Record Type: Journal Article
• Authors: Grazioli, Alison; Podell, Jamie E; Iacono, Aldo; Krupnik, Alexander Sasha; Madathil, Ronson J; Shah, Sanjeev R
• Is Part Of: Perfusion. Volume 38:Number 1(2023)
• Page Start: 193
• Page End: 196
• Publication Date: 2023-01
• Subjects: hyperammonemia -- hemodialysis -- hemofiltration -- orthotopic lung transplantation -- hyperosmotic therapy -- renal replacement therapy -- extracorporeal membrane oxygenation; Perfusion (Physiology) -- Periodicals; Blood -- Circulation, Artificial -- Periodicals; Heart -- Surgery -- Periodicals; Extracorporeal Circulation -- Periodicals; Perfusion -- Periodicals; Circulation extracorporelle -- Périodiques; Perfusion -- Périodiques; 617.41
• DOI: 10.1177/02676591211035939
• Languages: English
• ISSNs: 0267-6591

Abstract

After orthotopic lung transplantation, hyperammonemia can be a rare complication secondary to infection by organisms that produce urease or inhibit the urea cycle. This can cause neurotoxicity, cerebral edema, and seizures. Ammonia is unique in that it has a large volume of distribution. However, it is also readily dialyzable given its small molecular weight. As such, removal of ammonia requires renal replacement modalities that can both rapidly remove ammonia from the plasma space and allow for continuous removal to prevent rebound accumulation from intracellular stores. Prevention of iatrogenic osmotic lowering in this setting is required to prevent worsening of cerebral edema. Herein, we describe use of sequential in-line renal replacement therapy using both intermittent hemodialysis and continuous venovenous hemofiltration within an extracorporeal membrane oxygenation circuit in conjunction with higher sodium dialysate and 7.5% hypertonic saline to achieve these treatment goals.