CONTINUOUS VENOVENOUS HEMOFILTRATION (CVVH) AND METHYLMALONIC ACIDEMIA

A 4-day-old newborn started vomiting and developed dyspnea and cerebra l convulsion. Antibiotic treatment was started for suspected sepsis. L aboratory workup revealed a metabolic acidosis, hyperlactatemia (600 m umol/l) and hyperammonemia. Conservative treatment did not improve hyp erammonemia so that a continuous veno-venous hemofiltration was introd uced. Circulation was monitored by a pediatric adapted BM 11 (Dialyse Technik, Ettlingen, Germany) using a Minifilter plus (Amicon, USA). Ac hieving a bloodflow rate of 30 ml/min and a filtration rate of 250 ml/ hour. NH4 was 300 mumol/l after 4 hours and 45 mumol/l after 18 hours of CVVH treatment, respectively CVVH was ceased. NH4 remained low unde r special diet, carnithin and Na-benzoacid supplementation.