Browsing by Author "Juanet Lecaros, Cristian Ignacio"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Enfrentamiento fisiopatológico del paciente con hiponatremia. Diagnóstico diferencial y tratamiento
    (2025) Sepúlveda Palamara, Rodrigo Andrés; Sharp Segovia, Joaquin Andres; Juanet Lecaros, Cristian Ignacio; Avila Jimenez, Eduardo Rodolfo
    La hiponatremia ([Na+] plasmático <135 mEq/L) es el trastorno hidroelectrolítico más frecuente, sin embargo, no siempre traduce un estado de hipotonía del agua corporal (Osm plasmática <275 mOsm/kg). Los mecanismos subyacentes a una hiponatremia hipotónica son la sobrecarga acuosa y/o una excreción ineficiente de agua libre a nivel renal. Múltiples causas pueden provocar este trastorno, pero reconocer su etiología es un gran desafío. Se requiere una evaluación clínica completa junto a un análisis de laboratorio exhaustivo, ya que no basta un parámetro aislado. La severidad de una hiponatremia depende de la etiología, intensidad y velocidad de instauración, así, un diagnóstico inadecuado junto con una corrección apresurada pueden generar más daño. Por otro lado, existen muchas contro-versias respecto a la mejor forma de realizar un tratamiento óptimo. En esta revisión se presenta un enfoque fisiopatológico que permite interpretar los mecanismos patogénicos, diagnosticar el trastorno y sus causas específicas, corregir el estado de hipotonía y gestionar de manera adecuada y segura al paciente con hiponatremia
  • Thumbnail Image
    Item
    Prolonged intermittent high-volume hemofiltration as kidney replacement therapy in critically ill patients
    (Springer Nature, 2025) Sepúlveda Palamara, Rodrigo Andrés; Huidobro Espinosa, Juan Pablo; Juanet Lecaros, Cristian Ignacio; Espinosa, María E.; González Muñoz, Loredana Elizabeth; Rot Cisternas, Ívica Damaris; Bello, Francisca; Salinas, Daniela; Hidalgo, Francisco; Delgado, Pablo; Roessler Barron, Eric
    Background Prolonged and intermittent high-volume hemofiltration (HVHF) can be performed in extremely critical patients for hemodynamic support. In addition, it can serve as a kidney replacement therapy, given its large ultrafiltration volume. Our objective is to characterize the depuration properties of HVHF and hemodynamic tolerance. Methods This was a retrospective cohort study. All adult critical patients who received HVHF in a university hospital during 2021 were included. Demographic variables, past medical history, pre- and post-HVHF blood tests, and hemodynamic tolerance were evaluated. Results A total of 133 HVHF sessions were performed on 74 critical patients (age 61.1 ± 14.8 years, 43.2% women, and sequential organ failure assessment (SOFA) score 15.5 ± 3.8). All HVHF sessions were performed with prefilter replacement fluid, and 83.5% without anticoagulation. Time (QT) was 337 ± 86 min, with replacement flow rate (QR) at 81 ± 21 mL/kg/h. Hypotension occurred in 19.6% of the procedures at connection and 6.8% during therapy with no precipitating factor. Norepinephrine dose decreased ≥ 20% in 47.1% of the HVHF sessions. Single-pool urea Kt/V (spKt/V) was 0.52 ± 0.17. In HVHF of QT 6–8 h, spKt/V was 0.58 ± 0.17. Higher spKt/V was associated with higher QT and high QR. Post-HVHF sodium was significantly associated with sodium in the replacement fluid. Before HVHF, 18% had hyperkalemia (5.9 ± 1.1 mEq/L). Post-therapy kalemia was 4.8 ± 0.6 mEq/L. Post-HVHF potassium was associated with QR and ultrafiltration. Conclusions Prolonged and intermittent HVHF could serve as an alternative kidney replacement therapy in critically ill patients because it provides adequate control of the internal environment, allows withdrawal anticoagulation, favors patient mobility for procedures and treatments, and provides hemodynamic support.