Hyponatremia in Heart Failure: why it is important and what should we do about it?
|
|
- Basil Clifford Dickerson
- 6 years ago
- Views:
Transcription
1 Objectives Hyponatremia in Heart Failure: why it is important and what should we do about it? Pathophysiology of sodium and water retention in heart failure Hyponatremia in heart failure (mechanism and prognostic importance) Richard G. Kiel, M.D. Associate Clinical Professor of Medicine, UCSF Director, Advanced Heart Failure and Mechanical Circulator Support, UCSF-Fresno MEP How to treat volume overload in heart failure Aquaresis vs. diuresis in treating volume overload in patients with heart failure and hyponatremia Pathophysiology of Heart Failure Vicious Circle of Water Retention Schrier RW. J Am Coll Cardiol. 2006; 47: 1-8. Schrier RW. J Am Coll Cardiol. 2006; 47:
2 Pathophysiology of hyponatremia in acute decompensated heart failure Dilutional Hyponatremia Increased sensitivity of osmotic AVP release lower osmo-checkpoint Increased nonosmotic AVP release Impaired AVP degradation Increased thirst Decreased distal nephron flow Verbrugge et al. J Am Coll Cardiol. 2015; 65: Mechanism of action Baroreceptor activation/angtiotensin II Baroreceptor activation/angtiotensin II Liver/kidney dysfunction Baroreceptor activation/angtiotensin II Impaired glomerular filtration/increase reabsorption in proximal tubes Pathophysiology of hyponatremia in acute decompensated heart failure Depletional Hyponatremia Low sodium intake Exaggerated nonurinary sodium loss Exagerated natriuresis Sodium shift toward the intracellular compartment Verbrugge et al. J Am Coll Cardiol. 2015; 65: Mechanism of action Salt-restricted diet Diarrhea, ascites Diuretics, osmotic diuresis Potassium and/or magnesium deficiency Differentiate dilutional verus depletion If volume overload you can assume at least a component of dilutional Urine osmolality should be depressed (<100 mosm/l) in depletional but not dilutional hyponatremia. Low urinary sodium (<50mEq/L) is a strong argument for electrolyte depletion Plasma hypotonicity Confirm plasma hypotonicity (<285 mosm/l) Pseudohyponatrmia: Elevated triglycerides, immunoglobulins, monoclonal gammanopathies can cause falsely low Na concentrations Presence of effective osmoles (e.g. hyperglycemia) can falsely increase serum Na concentrations 2
3 Role of Vasopressin in Heart Failure Free Water Excretion in Patients Without Heart Failure Dilutional hyponatremia, high BUN Verbrugge FH. J Am Coll Cardiol. 2015; 65: Verbrugge FH. J Am Coll Cardiol. 2015; 65: Free Water Excretion is Impaired in Heart Failure Hyponatremia in patients hospitalized for heart failure 20% with Na < 135 mmol/l Verbrugge FH. J Am Coll Cardiol. 2015; 65: Gheorghiade M et al. Eur Heart J. 2007; 28:
4 Sodium and Survival in Heart Failure BUN and Survival in Heart Failure Klein L et al. Circulation 2005; 111: Klein L et al. Circ Heart Fail. 2008; 1: Volume Management in Heart Failure Diuretics Loop; thiazide; acetazolamide Aquaretics (vaptans) Tolvaptan Inotropic agents Dopamine; dobutamine Vasodilators Nesiretide, nitroglycerin, nitroprusside Ultrafiltration Continuous; intermittent Diuretic Strategies Need combination (due to braking and tolerance) Loop + Thiazide + Acetazolamide Potency and protein binding Bumetanide > Torsemide > Furosemide High vs. Low dose High dose better (DOSE - HF trial) IV Bolus vs. IV Drip No difference (DOSE - HF trial) High dose vs. Low dose + Dopamine Dopamine improves renal blood flow and size of renal arteries 4
5 Aquaretics (Vaptans) Tolvaptan is the most studied V 2 antagonist Studied in chronic heart failure, acute heart failure Hemodynamic studies Remodeling studies Potential of improving volume status and serum sodium No increases in short or long term mortality No adverse effects on blood pressure, heart rate, renal function, electrolytes Hemodynamics Effects of Tolvaptan Slightly better reduction in filling pressures with tolvaptan Schrier RW et al. N Engl J Med. 2006; 355: ; Udelson JE et al. J Am Coll Cardiol. 2008; 52: ; Lehrich RW et al. J Am Soc Nephrol. 2008; 19: Udelson JE et al. J Am Coll Cardiol. 2008; 52: Effects of Tolvaptan on PCWP Effects of Tolvaptan on Urine Output Sustained reduction in filling pressures with tolvaptan Udelson JE et al. J Am Coll Cardiol. 2008; 52: Better diuresis with single dose tolvaptan No changes in renal function and electrolytes Udelson JE et al. J Am Coll Cardiol. 2008; 52:
6 Renal Effects of Tolvaptan * p < 0.05 Costello-Boerrigter et al. Am J Physiol Renal Physiol 2006; 290: F TLV compared to furosemide: Similar urine output No changes in electrolytes No changes in osmolality Preserved renal blood flow Effects of Tolvaptan vs. Furosemide TLV produced sustained decrease in body weight, increased urine volume, transient sodium increase (within normal range) and no change in potassium Udelson JE et al. J Card Fail. 2011; 17: Change in Global Clinical Status During Hospitalization in EVEREST Dyspnea in Hospitalized Patients with Hyponatremia in EVEREST Gheorghiade M et al. JAMA. 2007; 297: Hauptman PJ et al. J Card Fail. 2013; 19:
7 Diuretics in Hospitalized Patients with Hyponatremia in EVEREST * p < 0.05 Body Weight and Sodium in EVEREST * p < * p < (in pts. with Na < 134 mmol/l) Hauptman PJ et al. J Card Fail. 2013; 19: Konstam MA et al. JAMA. 2007; 297: Body Weight and Sodium in EVEREST All-Cause Mortality in EVEREST Konstam MA et al. JAMA. 2007; 297: Konstam MA et al. JAMA. 2007; 297:
8 Event Analysis in EVEREST Hauptman PJ et al. J Card Fail. 2013; 19: Managing Volume Overload in Heart Failure: Diuretics vs. Vaptans Vaptans Diuretics Urine Output ã ã Serum Sodium ã ä Serum Potassium No change ä Plasma Osmolality ã ä Blood Pressure No change ä BUN/Creatinine No change ã Renal Blood Flow ã ä GFR ã ä Renal vascular resistance ä ã Vasopressin level ã ã Norepinephrine level No change ã Plasma renin activity No change ã Aldosterone level No change ã Costello-Boerrigter et al. Am J Physiol Renal Physiol 2006; 290: F Conclusions Volume overload is the main reason for hospitalizations in pts. with HF Up to 20% of pts. develop dilutional hyponatremia Volume control is paramount Use diuretics, vaptans, inotropes, ultrafiltration Diuretics can lead to worse neurohormonal activity, renal function and hyponatremia Diuretic resistance leads to use of combination Tolvaptan: better symptomatic relief than diuretics in HFrEF pts. with hyponatremia No deleterious hemodynamic effects, preserves renal function and potassium, corrects hyponatremia 8
The Cardiorenal Syndrome in Heart Failure
The Cardiorenal Syndrome in Heart Failure Van N Selby, MD Assistant Professor of Medicine Advanced Heart Failure Program, UCSF October 9, 2015 Disclosures None 1 Cardiorenal Syndrome (CRS) A pathophysiologic
More informationHyponatremia as a Cardiovascular Biomarker
Hyponatremia as a Cardiovascular Biomarker Uri Elkayam, MD Professor of Medicine University of Southern California Keck School of Medicine elkayam@usc.edu Disclosure Research grant from Otsuka for the
More informationThe Art and Science of Diuretic therapy
The Art and Science of Diuretic therapy Dr. Fayez EL Shaer Associate Professour of cardiology Consultant cardiologist MD, MSc, PhD, CBNC, NBE FESC, ACCP, FASNC,HFA KKUH, KFCC Heart failure: fluid overload
More informationMedical Management of Acutely Decompensated Heart Failure. William T. Abraham, MD Director, Division of Cardiovascular Medicine
Medical Management of Acutely Decompensated Heart Failure William T. Abraham, MD Director, Division of Cardiovascular Medicine Orlando, Florida October 7-9, 2011 Goals of Acute Heart Failure Therapy Alleviate
More informationState of the Art Treatment - Hyponatremia, Heart Rate, et al
State of the Art Treatment - Hyponatremia, Heart Rate, et al Uri Elkayam, MD Professor of Medicine University of Southern California Keck School of Medicine elkayam@usc.edu Disclosure Research grant from
More informationManagement of Acute Heart Failure
Management of Acute Heart Failure Uri Elkayam, MD Professor of Medicine University of Southern California School of Medicine Los Angeles, California elkayam@usc.edu ADHF Treatments Goals.2 Improve symptoms.
More informationUri Elkayam, MD. Professor of Medicine University of Southern California Keck School of Medicine
Mihai Gheorghiade, MD Memorial Lecture Use of Vasopressin Antagonists for the Management of Hyponatremia and Volume Overload Uri Elkayam, MD Professor of Medicine University of Southern California Keck
More informationChapter 21. Diuretic Agents. Mosby items and derived items 2008, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 21 Diuretic Agents Renal Structure and Function Kidneys at level of umbilicus Each weighs 160 to 175 g and is 10 to 12 cm long Most blood flow per gram of weight in body 22% of cardiac output (CO)
More informationOvercoming the Cardiorenal Syndrome
Overcoming the Cardiorenal Syndrome October 29, 2016 Randall C Starling MD MPH FACC FESC FHFSA FHFA Professor of Medicine Heart & Vascular Institute Cleveland Clinic Lerner College of Medicine Cleveland
More informationCase Report Tolvaptan in the Treatment of Acute Hyponatremia Associated with Acute Kidney Injury
Case Reports in Nephrology Volume 2013, Article ID 801575, 4 pages http://dx.doi.org/10.1155/2013/801575 Case Report Tolvaptan in the Treatment of Acute Hyponatremia Associated with Acute Kidney Injury
More informationAccepted Manuscript. Tolvaptan in Acute Heart Failure: Time to Move On. Randall C. Starling, MD MPH, James B. Young, MD
Accepted Manuscript Tolvaptan in Acute Heart Failure: Time to Move On Randall C. Starling, MD MPH, James B. Young, MD PII: S0735-1097(16)35324-4 DOI: 10.1016/j.jacc.2016.09.005 Reference: JAC 22962 To
More informationFrom Sodium Retention to Therapy for Refractory Ascites The Role for New Drugs. Florence Wong University of Toronto. Falk Symposium October 14, 2007
From Sodium Retention to Therapy for Refractory Ascites The Role for New Drugs Florence Wong University of Toronto Falk Symposium October 14, 2007 Sodium Retention in Cirrhosis Occurs as a result of hemodynamic
More informationTherapeutic Potential of Vasopressin-Receptor Antagonists in Heart Failure
J Pharmacol Sci 124, 000 000 (2014) Journal of Pharmacological Sciences The Japanese Pharmacological Society Current Perspective Therapeutic Potential of Vasopressin-Receptor Antagonists in Heart Failure
More informationA Study To Evaluate The Efficacy Of Tolvaptan In Correction Of Hyponatremia And Its Effect On..
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 5 Ver. 11 (May. 2018), PP 29-34 www.iosrjournals.org A Study To Evaluate The Efficacy Of Tolvaptan
More informationHeart Failure and Renal Disease Cardiorenal Syndrome
Advanced Heart Failure: Clinical Challenges Heart Failure and Renal Disease Cardiorenal Syndrome 17 th Apr 2015 Ju-Hee Lee, M.D Cardiovascular Center, Chungbuk National University Hospital Chungbuk National
More informationBeneficial Role of Tolvaptan in the Control of Body Fluids Without Reductions in Residual Renal Function in Patients Undergoing Peritoneal Dialysis
Advances in Peritoneal Dialysis, Vol. 29, 2013 Takefumi Mori, 1,2,3 Ikuko Oba, 1 Kenji Koizumi, 1 Mayumi Kodama, 1 Miwako Shimanuki, 1 Mizuho Tanno, 1 Makiko Chida, 1 Mai Saito, 1 Hideyasu Kiyomoto, 1
More informationCase Report Triple Diuretics and Aquaretic Strategy for Acute Decompensated Heart Failure due to Volume Overload
Case Reports in Cardiology Volume 2013, Article ID 750794, 4 pages http://dx.doi.org/10.1155/2013/750794 Case Report Triple Diuretics and Aquaretic Strategy for Acute Decompensated Heart Failure due to
More informationArginine vasopressin has attracted attention as a potentially
New Drugs and Technologies Arginine Vasopressin Antagonists for the Treatment of Heart Failure and Hyponatremia John J. Finley IV, MD; Marvin A. Konstam, MD; James E. Udelson, MD Arginine vasopressin has
More informationMedical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011
Medical Treatment for acute Decompensated Heart Failure Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 2010 HFSA guidelines for ADHF 2009 focused update of the 2005 American College
More informationMedical Management of Acute Heart Failure
Critical Care Medicine and Trauma Medical Management of Acute Heart Failure Mary O. Gray, MD, FAHA Associate Professor of Medicine University of California, San Francisco Staff Cardiologist and Training
More informationIposodiemia: diagnosi e trattamento
Iposodiemia: diagnosi e trattamento Enrico Fiaccadori Unita di Fisiopatologia dell Insufficienza Renale Acuta e Cronica Dipartimento di Medicina Clinica e Sperimentale Universita degli Studi di Parma Hyponatremia
More informationCardiorenal Syndrome: What the Clinician Needs to Know. William T. Abraham, MD Director, Division of Cardiovascular Medicine
Cardiorenal Syndrome: What the Clinician Needs to Know William T. Abraham, MD Director, Division of Cardiovascular Medicine Orlando, Florida October 7-9, 2011 Renal Hemodynamics in Heart Failure Glomerular
More information** TMP mean page 340 in 12 th edition. Questions 1 and 2 Use the following clinical laboratory test results for questions 1 and 2:
QUESTION Questions 1 and 2 Use the following clinical laboratory test results for questions 1 and 2: Urine flow rate = 1 ml/min Urine inulin concentration = 100 mg/ml Plasma inulin concentration = 2 mg/ml
More informationPivotal Role of Renal Function in Acute Heart failure
Pivotal Role of Renal Function in Acute Heart failure Doron Aronson MD, FESC Department of Cardiology RAMBAM Health Care Campus Haifa, Israel Classification and definitions of cardiorenal syndromes CRS
More informationHeart Failure and Renal Failure. Gerasimos Filippatos, MD, FESC, FHFA President HFA
Heart Failure and Renal Failure Gerasimos Filippatos, MD, FESC, FHFA President HFA Definition Epidemiology Pathophysiology Management (?) Recommendations for NHLBI in cardiorenal interactions related to
More informationJournal Watch. January. REVIEW: Diuretic Resistance in heart failure HEART FAILURE AND TRANSPLANTATION
Journal Watch January 2018 Lavanya Bellumkonda, MD, PhD Yale University School of Medicine New Haven, Connecticut, USA lavanya.bellumkonda@yale.edu Josephine Chou, MD Yale University School of Medicine
More informationComparison of tolvaptan treatment between patients with the SIADH and congestive heart failure: a single-center experience
ORIGINAL ARTICLE Korean J Intern Med 2018;33:561-567 Comparison of tolvaptan treatment between patients with the SIADH and congestive heart failure: a single-center experience Gun Ha Park 1,2, Chang Min
More informationObjectives 6/14/2016. Cardiorenal Syndrome: Critical Link Between Heart and Kidney
Cardiorenal Syndrome: Critical Link Between Heart and Kidney Chris M. Bell, ACNP Cardiology Associates of North Mississippi Objectives Review the 5 Subtypes of the Cardiorenal Syndrome (CRS) Discuss the
More informationHyponatremia. Mis-named talk? Basic Pathophysiology
Hyponatremia Great Lakes Hospital Medicine Symposium by Brian Wolfe, MD Assistant Professor of Internal Medicine University of Colorado Denver Mis-named talk? Why do we care about Hyponatremia? concentration
More informationVolume Control in. Wafaa El Aroussy,MD Prof of Cardiology Kasr El Aini Faculty of Medicine September 29 th, 2011
Volume Control in Heart Failure Wafaa El Aroussy,MD Prof of Cardiology Kasr El Aini Faculty of Medicine September 29 th, 2011 What is Heart Failure Heart failure is a multisystem disorder which is characterised
More informationV2 Receptor Antagonist; Tolvaptan
Review ISSN 1738-5997 (Print) ISSN 2092-9935 (Online) Electrolyte Blood Press 9:50-54, 2011 http://dx.doi.org/10.5049/ebp.2011.9.2.50 V2 Receptor Antagonist; Tolvaptan Joo-Hark Yi, M.D. Hyun-Jong Shin,
More informationCardio-Renal Syndrome in Acute Heart Failure:
Cardio-Renal Syndrome in Acute Heart Failure: Target for Therapy Marvin A. Konstam, M.D. Research support and/or consulting relevant to this lecture: Merck, Otsuka, Johnson & Johnson; Amgen; Cardiokine
More informationFluid and electrolyte balance, imbalance
Fluid and electrolyte balance, imbalance Body fluid The fluids are distributed throughout the body in various compartments. Body fluid is composed primarily of water Water is the solvent in which all solutes
More informationCardiorenal and Renocardiac Syndrome
And Renocardiac Syndrome A Vicious Cycle Cardiorenal and Renocardiac Syndrome Type 1 (acute) Acute HF results in acute kidney injury Type 2 Chronic cardiac dysfunction (eg, chronic HF) causes progressive
More informationNATURAL HISTORY AND SURVIVAL OF PATIENTS WITH ASCITES. PATIENTS WHO DO NOT DEVELOP COMPLICATIONS HAVE MARKEDLY BETTER SURVIVAL THAN THOSE WHO DEVELOP
PROGNOSIS Mortality rates as high as 18-30% are reported for hyponatremic patients. High mortality rates reflect the severity of underlying conditions and are not influenced by treatment of hyponatremia
More informationSalt Sensitivity: Mechanisms, Diagnosis, and Clinical Relevance
Salt Sensitivity: Mechanisms, Diagnosis, and Clinical Relevance Matthew R. Weir, MD Professor and Director Division of Nephrology University of Maryland School of Medicine Overview Introduction Mechanisms
More informationDiuretics having the quality of exciting excessive excretion of urine. OED. Inhibitors of Sodium Reabsorption Saluretics not Aquaretics
Diuretics having the quality of exciting excessive excretion of urine. OED Inhibitors of Sodium Reabsorption Saluretics not Aquaretics 1 Sodium Absorption Na Entry into the Cell down an electrochemical
More informationQuestions? Homework due in lab 6. PreLab #6 HW 15 & 16 (follow directions, 6 points!)
Questions? Homework due in lab 6 PreLab #6 HW 15 & 16 (follow directions, 6 points!) Part 3 Variations in Urine Formation Composition varies Fluid volume Solute concentration Variations in Urine Formation
More informationContents DEFINITION. TYPES EPIDEMIOLOGY PATHOPHYSIOLOGY. CLINICAL PRESENTATION. DIAGNOSIS. TREATMENT. EVALUATION OF THERAPEUTIC OUTCOMES.
Heart Failure Contents DEFINITION. TYPES EPIDEMIOLOGY PATHOPHYSIOLOGY. CLINICAL PRESENTATION. DIAGNOSIS. TREATMENT. EVALUATION OF THERAPEUTIC OUTCOMES. DEFINITION Heart failure (HF) is a progressive clinical
More informationAs life expectancy increases, the proportion of elderly
Clinical Studies Effectiveness and Adverse Events of Tolvaptan in Octogenarians With Heart Failure Interim Analyses of Samsca Post-Marketing Surveillance In Heart failure (SMILE Study) Koichiro Kinugawa,
More informationKeynote Address II Managing Acute Heart Failure: What Can We Do to Improve Outcomes?
Keynote Address II Managing Acute Heart Failure: What Can We Do to Improve Outcomes? 24 th Annual San Diego Heart Failure Symposium June 1-2, 2018 La Jolla, CA Barry Greenberg, MD Distinguished Professor
More informationHeart failure. Failure? blood supply insufficient for body needs. CHF = congestive heart failure. increased blood volume, interstitial fluid
Failure? blood supply insufficient for body needs CHF = congestive heart failure increased blood volume, interstitial fluid Underlying causes/risk factors Ischemic heart disease (CAD) 70% hypertension
More informationTiny Jaarsma Linköping University No conflict of interest
Detrimental effects of sodium in heart failure - Tiny Jaarsma Linköping University No conflict of interest Sodium restriction in Heart Failure Why? Prevention of heart failure Blood pressure treatment
More informationBiomarkers for optimal management of heart failure. Cardiorenal syndrome. Veli-Pekka Harjola Helsinki University Central Hospital Helsinki, Finland
Biomarkers for optimal management of heart failure Cardiorenal syndrome Veli-Pekka Harjola Helsinki University Central Hospital Helsinki, Finland Presenter Disclosure Information V-P Harjola The following
More informationTHE KIDNEY IN HYPOTENSIVE STATES. Benita S. Padilla, M.D.
THE KIDNEY IN HYPOTENSIVE STATES Benita S. Padilla, M.D. Objectives To discuss what happens when the kidney encounters low perfusion To discuss new developments and clinical application points in two scenarios
More informationAdvanced Care for Decompensated Heart Failure
Advanced Care for Decompensated Heart Failure Sara Kalantari MD Assistant Professor of Medicine, University of Chicago Advanced Heart Failure, Mechanical Circulatory Support and Cardiac Transplantation
More informationHeart failure (HF) is a chronic and progressive disease
In-Depth Review Cardiorenal Syndrome in Acute Decompensated Heart Failure Mohammad Sarraf, Amirali Masoumi, and Robert W. Schrier University of Colorado Denver, Aurora, Colorado Renal dysfunction is highly
More informationSection 12: Evaluation and Management of Patients With Acute Decompensated Heart Failure
Journal of Cardiac Failure Vol. 12 No. 1 2006 Section 12: Evaluation and Management of Patients With Acute Decompensated Heart Failure Overview Acute decompensated heart failure (ADHF) has emerged as a
More informationComposition: Each Tablet contains. Pharmacokinetic properties:
Composition: Each Tablet contains Torsemide 5/10/20/40/100mg Pharmacokinetic properties: Torsemide is well absorbed from the gastrointestinal tract. Peak serum concentrations are achieved within 1 hour
More informationBIPN100 F15 Human Physiology (Kristan) Problem Set #8 Solutions p. 1
BIPN100 F15 Human Physiology (Kristan) Problem Set #8 Solutions p. 1 1. a. Proximal tubule. b. Proximal tubule. c. Glomerular endothelial fenestrae, filtration slits between podocytes of Bowman's capsule.
More informationBlood Pressure Regulation 2. Faisal I. Mohammed, MD,PhD
Blood Pressure Regulation 2 Faisal I. Mohammed, MD,PhD 1 Objectives Outline the intermediate term and long term regulators of ABP. Describe the role of Epinephrine, Antidiuretic hormone (ADH), Renin-Angiotensin-Aldosterone
More informationBlood Pressure Regulation 2. Faisal I. Mohammed, MD,PhD
Blood Pressure Regulation 2 Faisal I. Mohammed, MD,PhD 1 Objectives Outline the intermediate term and long term regulators of ABP. Describe the role of Epinephrine, Antidiuretic hormone (ADH), Renin-Angiotensin-Aldosterone
More informationTherapeutics of Diuretics
(Last Updated: 08/22/2018) Created by: Socco, Samantha Therapeutics of Diuretics Thambi, M. (2017). The Clinical Use of Diuretics. Lecture presented at PHAR 503 Lecture in UIC College of Pharmacy, Chicago.
More informationDIURETICS-4 Dr. Shariq Syed
DIURETICS-4 Dr. Shariq Syed AIKTC - Knowledge Resources & Relay Center 1 Pop Quiz!! Loop diuretics act on which transporter PKCC NKCC2 AIKTCC I Don t know AIKTC - Knowledge Resources & Relay Center 2 Pop
More informationWales Critical Care & Trauma Network (North) Management of Hyponatraemia in Intensive Care Guidelines
Wales Critical Care & Trauma Network (North) Management of Hyponatraemia in Intensive Care Guidelines Author: Richard Pugh June 2015 Guideline for management of hyponatraemia in intensive care Background
More informationDefining and Managing the Cardiorenal Syndrome in Acute Decompensated Heart Failure. Barry M. Massie Professor of Medicine UCSF
Defining and Managing the Cardiorenal Syndrome in Acute Decompensated Heart Failure Barry M. Massie Professor of Medicine UCSF DISCLOSURES Consulting fees: Merck-Novacardia Novartis Bristol Myers Squibb
More informationObjectives. Objectives
Objectives Volume regulation entails the physiology of salt content regulation The edematous states reflect the pathophysiology of salt content regulation The mechanisms of normal volume regulation mediate
More informationHeart Failure. Nesiritide Does Not Improve Renal Function in Patients With Chronic Heart Failure and Worsening Serum Creatinine
Heart Failure Nesiritide Does Not Improve Renal Function in Patients With Chronic Heart Failure and Worsening Serum Creatinine David J. Wang, MD; Thomas C. Dowling, PhD; Dean Meadows, MD; Tomas Ayala,
More informationReview of Tolvaptan s Pharmacokinetic and Pharmacodynamic Properties and Drug Interactions
J. Clin. Med. 2014, 3, 1276-1290; doi:10.3390/jcm3041276 Review OPEN ACCESS Journal of Clinical Medicine ISSN 2077-0383 www.mdpi.com/journal/jcm Review of Tolvaptan s Pharmacokinetic and Pharmacodynamic
More informationFor more information about how to cite these materials visit
Author(s): Michael Heung, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Noncommercial Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/
More informationDIURETICS. Assoc. Prof. Bilgen Başgut
DIURETICS Assoc. Prof. Bilgen Başgut Classification of Diuretics The best way to classify diuretics is to look for their Site of action in the nephron A. Diuretics that inhibit transport in the Proximal
More informationAkash Ghai MD, FACC February 27, No Disclosures
Akash Ghai MD, FACC February 27, 2015 No Disclosures Epidemiology Lifetime risk is > 20% for American s older than 40 years old. > 650,000 new cases diagnosed each year. Incidence increases with age: 2%
More informationLESSON ASSIGNMENT. Diuretic and Antidiuretic Agents. After you finish this lesson you should be able to:
LESSON ASSIGNMENT SUBCOURSE MD0806 LESSON 8 Therapeutics III. Diuretic and Antidiuretic Agents. LESSON ASSIGNMENT Paragraphs 8-1--8-7. LESSON OBJECTIVES After you finish this lesson you should be able
More informationCardiorenal Syndrome Prof. Dr. Bülent ALTUN Hacettepe University Faculty of Medicine Department of Internal Medicine Division of Nephrology
Cardiorenal Syndrome Prof. Dr. Bülent ALTUN Hacettepe University Faculty of Medicine Department of Internal Medicine Division of Nephrology Heart and Kidney The kidney yin dominates water, The heart yang
More informationDr.Nahid Osman Ahmed 1
1 ILOS By the end of the lecture you should be able to Identify : Functions of the kidney and nephrons Signs and symptoms of AKI Risk factors to AKI Treatment alternatives 2 Acute kidney injury (AKI),
More informationHeart Failure (HF) Treatment
Heart Failure (HF) Treatment Heart Failure (HF) Complex, progressive disorder. The heart is unable to pump sufficient blood to meet the needs of the body. Its cardinal symptoms are dyspnea, fatigue, and
More informationDiagnostic Approach and Management of Inpatient Hyponatremia
REVIEW Diagnostic Approach and Management of Inpatient Hyponatremia Biff F. Palmer, MD Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Disclosure: B.F.
More informationFluids and electrolytes
Body Water Content Fluids and electrolytes Infants have low body fat, low bone mass, and are 73% or more water Total water content declines throughout life Healthy males are about 60% water; healthy females
More informationDysnatremias: All About the Salt? Internal Medicine Resident Lecture 1/12/16 Steve Schinker, MD
Dysnatremias: All About the Salt? Internal Medicine Resident Lecture 1/12/16 Steve Schinker, MD Water or salt? Dysnatremias In general, disorder of water balance, not sodium balance Volume status is tied
More information2016 Update to Heart Failure Clinical Practice Guidelines
2016 Update to Heart Failure Clinical Practice Guidelines Mitchell T. Saltzberg, MD, FACC, FAHA, FHFSA Medical Director of Advanced Heart Failure Froedtert & Medical College of Wisconsin Stages, Phenotypes
More informationG. Allen Bryant III, M.D.,F.A.S.N Director Medical Subspecialties LMH Co-Director Renal Services LMH LMPC Chairman of Board
G. Allen Bryant III, M.D.,F.A.S.N Director Medical Subspecialties LMH Co-Director Renal Services LMH LMPC Chairman of Board Presentation Outline/Goals Convince you that having combined LV dysfunction and
More informationHyponatremia, a common electrolyte imbalance, generally
Clinical 1 Contemporary Management Of Hyponatremia JOAN M. STACHNIK, PHARMD, BCPS Clinical Assistant Professor Department of Pharmacy Practice College of Pharmacy University of Illinois Medical Center
More informationRenal-Related Questions
Renal-Related Questions 1) List the major segments of the nephron and for each segment describe in a single sentence what happens to sodium there. (10 points). 2) a) Describe the handling by the nephron
More informationIV Fluids. I.V. Fluid Osmolarity Composition 0.9% NaCL (Normal Saline Solution, NSS) Uses/Clinical Considerations
IV Fluids When administering IV fluids, the type and amount of fluid may influence patient outcomes. Make sure to understand the differences between fluid products and their effects. Crystalloids Crystalloid
More informationSummary/Key Points Introduction
Summary/Key Points Introduction Scope of Heart Failure (HF) o 6.5 million Americans 20 years of age have HF o 960,000 new cases of HF diagnosed annually o 5-year survival rate for HF is ~50% Classification
More informationTOLVAPTAN: A NEW APPROACH TO THE MANAGEMENT OF EU- VOLEMIC AND HYPERVOLEMIC HYPONATREMIA
Volume 22, Issue 10 July 2007 TOLVAPTAN: A NEW APPROACH TO THE MANAGEMENT OF EU- VOLEMIC AND HYPERVOLEMIC HYPONATREMIA Olamide Oshikoya, Pharm. D Candidate Hyponatremia is the most common electrolyte disorder
More informationHyponatraemia: confident diagnosis, effective treatment and avoiding disasters. Dr James Ahlquist Endocrinologist Southend Hospital
Hyponatraemia: confident diagnosis, effective treatment and avoiding disasters Dr James Ahlquist Endocrinologist Southend Hospital Hyponatraemia: a common electrolyte disorder Electrolyte disorder Prevalence
More informationRenal Quiz - June 22, 21001
Renal Quiz - June 22, 21001 1. The molecular weight of calcium is 40 and chloride is 36. How many milligrams of CaCl 2 is required to give 2 meq of calcium? a) 40 b) 72 c) 112 d) 224 2. The extracellular
More informationHyponatremia Clinical Significance. Ágnes Haris MD PhD, St. Margit Hospital, Budapest
Hyponatremia Clinical Significance Ágnes Haris MD PhD, St. Margit Hospital, Budapest 1 Case of hyponatremia 70 years old male Past medical history: DM, HTN Heavy smoker (20 packs/day) Recently: epigastrial
More information9/24/2010 S U ts n ) s tie a 4.7 illio (m 3.5 ilu rt F a Outpatient e H Inpatient * 50 s 60 s 70 s >80
Exciting Times: Advances in Heart Failure Dana McGlothlin, MD Associate Professor of Medicine Advanced Heart Failure and Transplant Program Medical Director, CCU Overview HF Statistics Therapies for chronic
More informationAll but Vaptans. Pr Guy DECAUX Service de Médecine Interne Général Cliniques Universitaires Erasme, Bruxelles
All but Vaptans Pr Guy DECAUX Service de Médecine Interne Général Cliniques Universitaires Erasme, Bruxelles [ Na ] = Na + e + K + e TBW 60 y BW 66 kg, TBW ± 33 L, SNa 140 meq/l TBW 1 L SNa: 3% (or 4.2
More informationRegulation of Body Fluids: Na + and Water Linda Costanzo, Ph.D.
Regulation of Body Fluids: Na + and Water Linda Costanzo, Ph.D. OBJECTIVES: After studying this lecture, the student should understand: 1. Why body sodium content determines ECF volume and the relationships
More informationROSE-AHF and Beyond. Gerasimos Filippatos, FESC, FHFA President Heart Failure Association
ROSE-AHF and Beyond Gerasimos Filippatos, FESC, FHFA President Heart Failure Association From: Braunwald s Heart Disease. 9th ed. Philadelphia, Elsevier, 2011 Determinants and forms of worsening renal
More informationMechanism: 1- waterretention from the last part of the nephron which increases blood volume, venous return EDV, stroke volume and cardiac output.
Blood pressure regulators: 1- Short term regulation:nervous system Occurs Within secondsof the change in BP (they are short term because after a while (2-3 days) they adapt/reset the new blood pressure
More informationUniversity of Groningen. Diuretic response and renal function in heart failure ter Maaten, Jozine Magdalena
University of Groningen Diuretic response and renal function in heart failure ter Maaten, Jozine Magdalena IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish
More informationHyponatremia 11/4/2010. Learning Objectives
JAMES S. KALUS, PHARM.D, BCPS (AQ-CARDIOLOGY) Senior Manager, Patient Care Services, Department of Pharmacy Services Henry Ford Hospital, Detroit, MI NO RELATIONSHIPS TO DISCLOSE ANGELA STEWART, PHARM.D,
More information11/4/2010. Learning Objectives. Question 1. Question 2 PLEASE ANSWER THE HYPONATREMIA PRE-ACTIVITY TEST QUESTIONS. A. True B.
Faculty Disclosures James S. Kalus, PharmD, BCPS (AQ CV) Senior Manager, Patient Care Services Henry Ford Hospital, Detroit, MI NO RELATIONSHIPS TO DISCLOSE Saturday, October 23, 2010 Hemant Dhingra, MD
More informationInnovative Methodology
Am J Physiol Renal Physiol 290: F273 F278, 2006. First published September 27, 2005; doi:10.1152/ajprenal.00195.2005. Innovative Methodology Vasopressin-2-receptor antagonism augments water excretion without
More informationCardiorenal Syndrome
Cardiorenal Syndrome Peenida Skulratanasak, M.D. Division of Nephrology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University Definition of Cardiorenal syndrome (CRS) Structural
More informationDiuretic Agents Part-2. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Diuretic Agents Part-2 Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Potassium-sparing diuretics The Ion transport pathways across the luminal and basolateral
More informationCLASIFICATION OF ACUTE HEART FAILURE
CLASIFICATION OF ACUTE HEART FAILURE CLINICAL STATUS HR SBP mmhg CI L/min/m 2 PCWP mmhg Congestion Killip/Forrester Diuresis Hupoperfusion End-organ hypoperfusion I. Acute decompensated CHF +/ Low normal
More informationNovel Criteria of Urine Osmolality Effectively Predict Response to Tolvaptan in Decompensated Heart Failure Patients
Circulation Journal Official Journal of the Japanese Circulation Society http://www.j-circ.or.jp ORIGINAL ARTICLE Heart Failure Novel Criteria of Urine Osmolality Effectively Predict Response to Tolvaptan
More informationFaculty version with model answers
Faculty version with model answers Urinary Dilution & Concentration Bruce M. Koeppen, M.D., Ph.D. University of Connecticut Health Center 1. Increased urine output (polyuria) can result in a number of
More informationRENAL PHYSIOLOGY, HOMEOSTASIS OF FLUID COMPARTMENTS (4) Dr. Attila Nagy 2018
RENAL PHYSIOLOGY, HOMEOSTASIS OF FLUID COMPARTMENTS (4) Dr. Attila Nagy 2018 Intercalated cells Intercalated cells secrete either H + (Typ A) or HCO 3- (Typ B). In intercalated cells Typ A can be observed
More informationPharmacology I [PHL 313] Diuretics. Dr. Mohammad Nazam Ansari
Pharmacology I [PHL 313] Diuretics Dr. Mohammad Nazam Ansari Renal Pharmacology Kidneys: Each adult kidney weighs 125-170g in males and 115-155g in females, represent 0.5% of total body weight, but receive
More informationComposition of Body Fluids
Water and electrolytes disturbances Fluid and Electrolyte Disturbances Hao, Chuan-Ming MD Huashan Hospital Sodium balance Hypovolemia Water balance Hyponatremia Hypernatremia Potassium balance Hypokelemia
More informationبسم هللا الرحمن الرحيم ** Note: the curve discussed in this page [TF]/[P] curve is found in the slides, so please refer to them.**
بسم هللا الرحمن الرحيم ** Note: the curve discussed in this page [TF]/[P] curve is found in the slides, so please refer to them.** INULIN characteristics : 1 filtered 100 %. 2-Not secreted. 3-Not reabsorbed
More informationPRINCIPLES OF DIURETIC ACTIONS:
DIURETIC: A drug that increases excretion of solutes Increased urine volume is secondary All clinically useful diuretics act by blocking Na + reabsorption Has the highest EC to IC ratio = always more sodium
More informationTips & tricks on how to treat an acute heart failure patient with low cardiac output and diuretic resistance
Tips & tricks on how to treat an acute heart failure patient with low cardiac output and diuretic resistance J. Parissis Attikon University Hospital, Athens, Greece Disclosures ALARM investigator received
More informationBiomarkers, the Kidney and the Heart: Acute Kidney Injury
Biomarkers, the Kidney and the Heart: Acute Kidney Injury 12th Annual Conference on Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices San Diego May 13, 2016 Ravindra
More information