By adding dialysis to filtration, as in CVVHDF
, solutes are removed by both convection and diffusion, increasing the removal of small molecules more than middle-sized and large molecules.
He did not require further CVVHDF and his serum creatinine returned to a baseline level of 163 [micro]mol/l.
To the best of our knowledge, there has been no published experience with CVVHDF for metformin-induced lactic acidosis.
In those with metformin-induced lactic acidosis, CVVHDF appears effective.
Other researchers, however, have found that the principal determinant for blood urea nitrogen (BUN) clearance in CVVHDF is the BFR (Allen, Frost, & Hoenich, 1995; Golper, 1993; Reeves & Butt, 1995; Relton, Greenberg & Palevsky, 1992; Sands, Glidden, Jacavage, & Jones, 1996; Vincent et al.
A retrospective chart review was done for 15 patients, 9 men and 6 women, admitted to the cardiac intensive care unit (CICU) at Phoenix Baptist Hospital and Arizona Heart Hospital in Phoenix, Arizona, diagnosed with ARF or renal insufficiency and treated with CVVHDF between July 1998 and July 1999.
Charts were reviewed for the following: age, weight, diagnosis, hours on CVVHDF, BUN, creatinine, and BFR.
BFRs were documented in 4-hour increments on the CVVHDF flowsheets in patient charts.
Table 1 Descriptive statistics for BUN, Creatinine, Differences in BUN (DIFFBUN), Differences in Creatinine (DIFFCRTN), Blood Flow Rate, Weight, and Hours spent on CVVHDF (HOURSPST)
Therefore, the time spent on CVVHDF was recoded into four categories called the HOURSPST groups (see Table 4).
The bottom 5% (n = 12) was eliminated from the analysis as the readings reflected less than 2 hours on CVVHDF and would have skewed the results.
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