Hemodialysis international
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Extracorporeal treatments have an important role in the management of several types of poisonings and drug overdosage. Methanol poisoning is a major problem in large parts of the developing world, especially among the economically depressed, and is responsible for innumerable deaths annually. Poisoning occurs when methanol, a contaminant of bootlegged alcohol, is consumed unknowingly. ⋯ Delay in seeking medical attention contributes to mortality and morbidity. We report on a patient who presented to us 8 hr after consumption of countrymade alcohol with symptoms of methanol poisoning. Prompt administration of ethanol and institution of hemodialysis resulted in complete reversal of all manifestations.
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To assess the dry weight of chronic hemodialysis (HD) patients, the extravascular lung water index (ELWI) as a volume parameter was investigated to identify fluid overload. Forty-two patients (30 males, 12 females) with a mean age of 55.7+/-13.0 years who were clinically not overhydrated were connected to the PiCCO system before starting HD treatment. We determined ELWI (normal range 3-7 mL/kg) and the following parameters: global end-diastolic volume index (GEDI, normal range 680-800 mL/m(2)) and intrathoracic blood volume index (ITBI, normal range 850-1000 mL/m(2)) before and after HD to assess the volume status. ⋯ No significant relations among ELWI and mean arterial pressure (MAP), BNP, aldosterone, and renin were found. In conclusion, the use of ELWI is safe in chronic HD patients and identifies fluid-overloaded patients, who show no obvious signs of hypervolemia. The determination of ELWI is an excellent method to quantify the exact volume in chronic HD patients.
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Continuous renal replacement therapy (CRRT) is widely used in critically ill patients with acute renal failure (ARF). The survival of patients who require CRRT and the factors predicting their outcomes are not well defined. We sought to identify clinical features to predict survival in patients treated with CRRT. ⋯ Critically ill patients with ARF who require CRRT continue to have high in-hospital mortality. A shorter period of CRRT dependence, nonoliguria and higher baseline renal function may predict a more favorable prognosis. The majority of CRRT patients who survive their critical illness are independent of dialysis at the time of hospital discharge.