Intraoperative Management of Severe Hyponatremia During Orthotopic Liver Transplant Surgery: Case Series

Hyponatremia in patients with ESLD is a relatively common and serious condition that warrants gradual and meticulous correction to avoid rapid increase in serum sodium concentration, which can lead to osmotic demyelination syndrome, a devastating, potentially lethal, neurologic complication. Intraoperative management of hyponatremia in patients undergoing a liver transplant presents a substantial challenge because many surgery-related factors can result in a rapid increase in sodium concentration, such as massive transfusion of blood products, fluid shifts, and more. We present two cases, where recipients of liver transplants with severe/profound hyponatremia were successfully managed intraoperatively by using continuous veno-venous hemodialysis with specially modified dialysate.