Disorders of water and sodium homeostasis. Prof A. Pomeranz 2017
|
|
- Baldwin Stanley
- 6 years ago
- Views:
Transcription
1 Disorders of water and sodium homeostasis Prof A. Pomeranz 2017
2 Pediatric (Nephrology) Tool Box Disorders of water and sodium homeostasis
3 Pediatric Nephrology Tool Box Hyponatremiaand and Hypernatremia = Hospital outpatient clinic
4 How to interpret the tests? Serum Osmolality Can differentiate between true hyponatremia, pseudohyponatremia and hypertonic hyponatremia Urine Osmolality Can differentiate between primary polydipsiaand impaired free water excretion Urine Sodium concentration Can differentiate between hypovolemia hyponatremia and SIADH Assess volume status
5 Hyponatremiaand Hypernatremia
6 Hyponatremia Defined as sodium concentration < 135 meq/l Generally considered a disorder of wateras opposed to disorder of salt Results from increased water retention Normal physiologic measures allow a person to excrete up to 10 liters of water per day which protects against hyponatremia Thus, in most cases, some impairment of renal excretion of water is present
7 Causes Normal ADH response to low sodium is to be suppressed to allow maximally dilute urine to be excreted thereby raising serum sodium level Psuedohyponatremia High blood sugar (DKA) or protein level (triglycerides, multiple myeloma) can cause falsely depressed sodium levels Causes of Hyponatremiacan be classified based on either volume status or ADH level Hypovolemic, Euvolemic or Hypervolemic ADH inappropriately elevated or appropriately suppressed
8 ADH suppresion Conditions which ADH is suppressed Primary Polydipsia Low dietary solute intake Tea and Toast syndrome or Beer Potomania Advanced Renal Failure
9 ADH elevation Conditions which ADH is elevated Volume Depletion True volume depletion (i.e. bleeding) Effective circulating volume depletion (i.e. heart failure, NS and cirrhosis) Exercised induced hyponatremia Thiazide Diuretics Adrenal insufficiency SIADH
10 First step in Assessment: Are symptoms present? Hyponatremia can be asymptomatic and found by routine lab testing It may present with mild symptoms such as nausea and malaise (earliest) or headache and lethargy Or it may present with more severe symptoms such as seizures, coma or respiratory arrest
11 Presentation determines if immediate action is needed If severe symptoms are present, hypertonic saline needs to be administered to prevent further decline If severe symptoms are not present, can start by initiating fluid restriction and determining cause of hyponatremia Oral fluid restriction is good first step as it will prevent further drop in sodium NOTE: This does not mean that you can t give isotonic fluids to someone who is truly volume depleted
12 WHAT NEXT? With no severe symptoms and fluid restriction started, next step is to assess volume status to help determine cause Hypovolemic urine output, dry mucous membranes, sunken eyes Euvolemic normal appearing Hypervolemic Edema, past medical history, Jaundice (cirrhosis), NS, S3 (CHF)
13 Volume status helps predict cause Hypovolemia True Volume Depletion Adrenal insufficiency Thiazide overdose Exercised induced hyponatremia Euvolemia SIADH Primary Polydipsia Hypervolemia Cirrhosis, NS and CHF
14 Workup for Hyponatremia 3 mandatory lab tests (blood) Serum Osmolality Urine Osmolality Urine Sodium Concentration Additional labs depending on clinical suspicion TSH, cortisol(hypothryoidism or Adrenal insufficiency) Albumin, triglycerides and Serum Protein Electrophoresis (SPEP) (psuedohyponatremia).
15 How to interpret the tests? Serum Osmolality Can differentiate between true hyponatremia, pseudohyponatremiaand hypertonic hyponatremia Urine Osmolality Can differentiate between primary polydipsia and impaired free water excretion Urine Sodium concentration Can differentiate between hypovolemia hyponatremia and SIADH Assess volume status (help to determine the cause)
16 Additional Tests TSH high in hypothyroidism Cortisol low in adrenal insufficiency, though may be inappropriately normal in infection/stressful state, therefore should get Corti-Stim test to confirm Head CT and Chest Xray May see evidence of cerebral salt wasting or pulmonary disease which can both cause hyponatremia
17 And of course the not so common Iatrogenic infusion of hypotonic fluids ( Surgeon sign ) Ecstasy use increased water intake with inappropriate ADH secretion Underlying infections NSIAD Nephrogenic syndrome of inappropriate antidiuresis Hereditary disorder that presents with low sodium levels in newborn males with undetectable ADH levels (gain of function of the vasopressin receptor (V2R gene)) Reset Osmostat Occurs in children and pregnancy where regulated sodium set point is lowered
18 SIADH: Important concept to understand Caused by various etiologies CNS disease tumor, infection, CVA, Subarachnoid hemorrhage (SAH) Pulmonary disease TB, pneumonia, positive pressure ventilation Cancer Lung, pancreas, thymoma, ovary, lymphoma Drugs NSAIDs, SSRIs, diuretics, TCAs Surgery Postoperative Idopathic most common
19
20 Main diagnostic criteria for SIADH Clinical Euvolemia Hypotonic Hyponatremia Normal hepatic, renal and cardiac function Normal thyroid and adrenal function Urine osmolality greater than 100 mosm/kg though generally greater than mosm/kg in setting of low serum osmolality (inappropriate) Urine sodium level greater than 20 meq/l
21
22
23 Treatment is based on symptoms Patients with serum sodium above 120 are generally asymptomatic Symptoms tend to occur at serum sodium levels lower than 120 or when a rapid decline in sodium levels occur Patients can have mild symptoms at sodium concentrations of meq/l when this level is reached gradually
24
25
26
27
28 Severe symptoms present As stated earlier, symptoms dictate treatment If severe symptoms are present, starting bolus of 1ml/Kg ( ml) of 3% hypertonic saline (5meq/ml, which generally raise serum sodium level by 2-3 meq/l) Goals for correction: 1.5 to 2 meq/l per hour for first 3-4 hours until symptoms resolve Increase by no more than 10 meq/l in first 24 hrs Increase by no more than 18 meq/l in first 48 hrs
29
30 What if little to no symptoms are present? Oral fluid restriction is the first step NOTE: This only pertains to oral fluid, isotonic IV fluids do not count towards fluid intake If volume depletion is present, isotonic (0.9%) saline can be given intravenously Careful monitoring should be used whether symptoms are present or not Serum sodium levels should be drawn every 4-6 hours or more frequently if hypertonic saline is used
31 Formulas that may help: How much sodium does the patient need? Sodium deficit = Total body water x (desired Na actual Na) Total body water is estimated as lean body weight x 0.6 for children (0.5 for women or 0.6 for men)
32 How about an example: 30 kg girl with sodium level of 116 meq/l How much sodium will bring him up to 124 in the next 24 hours? Sodium needed = 0.6 x 30 x ( ) = 144 meq/l Hypertonic saline contains 500 meq/l of sodium Normal saline contains 154 meq/l of sodium
33 Example (continued) The patient needs 144 meqin next 24 hours That averages to 6 meqper hour (6x24=144) However, this will only raise the serum sodium by 0.33 per hour therefore, increasing the rate 30 ml to 45 ml will produce the desired rate of serum sodium increase of 1.0 to 1.5 meqper hour until symptoms resolve
34 What if the sodium increases too fast? The dreaded complication of increasing sodium too fast is Central Pontine Myelinolysis which is a form of osmotic demyelination Symptoms generally occur 2-6 days after elevation of sodium and usually either irreversible or only partially reversible Symptoms include: dysarthria, dysphagia, paraparesis, quadriparesis, lethargy, coma or even seizures
35
36 Risk Factors for demyelination Rate of correction over 24 hours more important than rate of correction in any one particular hour More common if sodium increases by more than 20 meq/l in 24 hours Very uncommon if sodium increases by 12 meq/l or less in 24 hours CT but preferably MRI to diagnose demyelinationif suspected, though imaging studies may not be positive for up to 4 weeks after initial correction
37 Treatment Options for demyelination CPM (Central Pontine Myelinolysis) is associated with poor prognosis Prevention is key Small studies have shown that plasmapharesisdone immediately after diagnosis may improve clinical outcomes
38 Summary of Hyponatremia Hyponatremia has variety of causes Treatment is based on symptoms Severe symptoms = Hypertonic Saline Mild or no symptoms = Fluid restriction Overcorrection, more than 12 meqincrease in 24 hours must be avoided with monitoring Serum Osmolality, Urine Osmolality and Urine sodium concentration are initial tests to order
39 Moving on to Hypernatremia Produced by either administration of hypertonic fluids or much more frequently, loss of thirst Because of extremely efficient regulatory mechanisms such as ADH and thirst, hypernatremiagenerally occurs only in people with prolonged lack of thirst mechanism Patients with loss of ADH (Diabetes Insipidus) usually can compensate with increased fluid intake
40 Causes of Hypernatremia Insensible and sweat losses GI losses Diabetes Insipidus(both central and nephrogenic) Osmotic Diuresis DKA or hyperglycemic hyperosmolar nonketotic state (HHNK) Hypothalamic lesions which affect thirst function Causes include tumors, granulomatous diseases or vascular disease Sodium Overload Infusion of Hypertonic sodium bicarbonate for metabolic acidosis
41 Symptoms of Hypernatremia Initial symptoms include lethargy, weakness and irritability Can progress to twitching, seizures or coma Resulting decrease in brain volume can lead to rupture of cerebral veins leading to hemorrhage Severe symptoms usually occur with rapid increase to sodium concentration of 158 meq or more Sodium concentration greater than 180 meqare associated with high mortality
42 Diagnosis of Hypernatremia Same labs as workup for hyponatremia: Serum osmolality, urine osmolality and urine sodium Urine sodium should be lower than 25 meq/l if and water and volume loss are cause. It can be greater than 100 meq/l when hypertonic solutions are infused or ingested If urine osmolalityis lower than serum osmolalitythen DI is present Administration of DDAVP will differentiate Urine osmolality will increase in central DI, no response in nephrogenic DI
43 Treatment of Hypernatremia First, calculate water deficit Water deficit = CBW x ((plasma Na/desired Na level)-1) CBW = current body water assumed to be 60% of body weight in children (50% of body weight in men and 40% in women) Sample (calculation): 30 kg girl with 168 meq/l How much water will it take to reduce her sodium to 140 meq/l
44 Calculation continued Water deficit = 0.6 x 30 ([168/140]-1) = 3.6 L But how fast should I correct it? Same as hyponatremia, sodium should not be lowered by more than 12 meq/l in 24 hours Overcorrection can lead to cerebral edema which can lead to encephalopathy, seizures or death So what does that mean for our patient? The 3.6 L which will lower the sodium level by 28 should be given over hours, or at a rate of 60 ml/hr Typical fluids given in form of D5 water
45 Summary of Hypernatremia Loss of thirst usually has to occur to produce hypernatremia Rate of correction same as hyponatremia D5 water infusion is typically used to lower sodium level Same diagnostic labs used: Serum osmolality, Urine osmolalityand Urine sodium Beware of overcorrection as cerebral edema may develop
46 Questions?
47
Basic approach to: Hyponatremia Adley Wong, MHS PA-C
2016 Topics in Acute and Ambulatory Care CAPA Conference 2018 for Advanced Practice Providers Basic approach to: Hyponatremia Adley Wong, MHS PA-C Goals Physiology of hyponatremia Why we care about hyponatremia
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 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 informationSouthern Derbyshire Shared Care Pathology Guidelines. Hyponatraemia in Adults
Southern Derbyshire Shared Care Pathology Guidelines Hyponatraemia in Adults Purpose of Guideline The investigation and management of adult patients with newly diagnosed hyponatraemia. Hyponatraemia can
More informationAbnormalities in serum sodium. David Metz Paediatric Nephrology
Abnormalities in serum sodium David Metz Paediatric Nephrology Basics Total body sodium regulated by aldosterone and ANP Mediated by intravascular volume (not sodium) RAAS and intrarenal determines Na
More informationGuidelines for management of. Hyponatremia
Guidelines for management of Hyponatremia Children s Kidney Centre University Hospital of Wales Cardiff CF14 4XW DISCLAIMER: These guidelines were produced in good faith by the authors reviewing available
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 informationHyponatremia and Hypokalemia
Hyponatremia and Hypokalemia Critical Care in the ED March 21 st, 2019 Hannah Ferenchick, MD 1 No financial disclosures 2 1 Outline: 1. Hyponatremia Diagnosis Initial treatment 2. Hyperkalemia Diagnosis
More informationWater (Dysnatremia) & Sodium (Dysvolemia) Disorders Ahmad Raed Tarakji, MD, MSPH, PGCertMedEd, FRCPC, FACP, FASN, FNKF, FISQua
Water (Dysnatremia) & Sodium (Dysvolemia) Disorders Ahmad Raed Tarakji, MD, MSPH, PGCertMedEd, FRCPC, FACP, FASN, FNKF, FISQua Assistant Professor Nephrology Unit, Department of Medicine College of Medicine,
More informationPare. Blalock. Shires. shock caused by circulating toxins treatment with phlebotomy. shock caused by hypovolemia treatment with plasma replacement
Pare shock caused by circulating toxins treatment with phlebotomy Blalock shock caused by hypovolemia treatment with plasma replacement Shires deficit in functional extracellular volume treatment with
More informationhyponatremia/hypo-osmolality/hypotonic dehydration
E87.1 Hypo-osmolality and hyponatremia CC Diagnosis: hyponatremia/hypo-osmolality/hypotonic dehydration Discussion is decreased sodium level in the blood. Serum osmolarity is low in true hyposmolar hyponatremia.
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 informationHyponatraemia- Principles, Investigation and Management. Sirazum Choudhury Biochemistry
Hyponatraemia- Principles, Investigation and Management Sirazum Choudhury Biochemistry Contents Background Investigation Classification Normal Osmolality General management and SIADH Cases Background Relatively
More informationDr. Dafalla Ahmed Babiker Jazan University
Dr. Dafalla Ahmed Babiker Jazan University objectives Overview Definition of dehydration Causes of dehydration Types of dehydration Diagnosis, signs and symptoms Management of dehydration Complications
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 informationHyponatraemia. Dr Andy Lewington Consultant Nephrologist/Honorary Clinical Associate Professor Leeds Teaching Hospitals
Hyponatraemia Dr Andy Lewington Consultant Nephrologist/Honorary Clinical Associate Professor Leeds Teaching Hospitals A.J.P.Lewington@leeds.ac.uk Disclosures of Interest Associate Clinical Director NIHR
More informationHyponatremia FOSPED 2018
Hyponatremia FOSPED 2018 Prof. Dr. Mirjam Christ-Crain Department of Endocrinology, Diabetology and Metabolism University Hospital Basel Schweizerische Gesellschaft für Endokrinologie und Diabetologie
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 informationBasic Fluid and Electrolytes
Basic Fluid and Electrolytes Chapter 22 Basic Fluid and Electrolytes Introduction Infants and young children have a greater need for water and are more vulnerable to alterations in fluid and electrolyte
More informationHyponatræmia: analysis
ESPEN Congress Nice 2010 Hyper- and hyponatraemia - serious and iatrogenic problems Hyponatræmia: analysis Mathias Plauth Hyponatremia Case Analysis Mathias Plauth Klinik für Innere Medizin Städtisches
More informationHYPONATRAEMIA: NUH GUIDELINE FOR INITIAL ASSESSMENT AND MANAGEMENT.
HYPONATRAEMIA: NUH GUIDELINE FOR INITIAL ASSESSMENT AND MANAGEMENT. HYPONATRAEMIA: SODIUM < 130 MMOL/L SIGNIFICANT. Symptoms/signs usually only occur when sodium < 125 mmol/l. Acute hyponatraemia is less
More informationEach tablet contains:
Composition: Each tablet contains: Tolvaptan 15/30mg Pharmacokinetic properties: In healthy subjects the pharmacokinetics of tolvaptan after single doses of up to 480 mg and multiple doses up to 300 mg
More informationFluids & Electrolytes
Fluids & Electrolytes Keihan Golshani, MD. Assistant professor of Clinical Emergency Medicine Emergency Medicine Department, Alzahra Hospital Isfahan Universities of Medical Sciences Physiology - Backround
More informationWorkshop on Hyponatremia
Workshop on Hyponatremia Debbie Rosenbaum MDCM FRCPc University of British Columbia Rocky Mountain / ACP Internal Medicine Meeting November 13 2009 Objectives Approach to diagnosis of hyponatremia Acute
More informationAssessment of the Patient with Endocrine Dysfunction. Objective. Endocrine. Endocrine Facts. Physical Assessment 10/3/2013
Objective Endocrine Jennifer MacDermott, MS, RN, ACNS BC, NP C, CCRN Clinical Nurse Specialist Surgical Intensive Care Unit Identify abnormal assessment finding sin a patient with endocrine dysfunction.
More informationEggplant: The Story of Sodium in Neurocritical Care
Eggplant: The Story of Sodium in Neurocritical Care Larry Burris, DO Medical Director NCC - Sanford Health Medical Director Renal Transplant - Sanford Health Assistant Professor of Medicine SSOM NaCl Facts
More informationCerebral Salt Wasting
Cerebral Salt Wasting Heather A Martin MSN, RN, CNRN, SCRN Swedish Medical Center 1 Disclosures none 2 2 The problem Hyponatremia is the most common disorder of electrolytes encountered in medical practice
More informationHyponatraemia. Detlef Bockenhauer
Hyponatraemia Detlef Bockenhauer Key message Plasma sodium can be low due to either excess water or deficiency of salt In clinical practice, dysnatraemias almost always reflect an abnormality of water
More informationNeurohypophysis. AVP Receptors. Hyponatremia in Pituitary Disorders 9/29/2016. Lewis S. Blevins, Jr., M.D.
in Pituitary Disorders Lewis S. Blevins, Jr., M.D. Neurohypophysis AVP secreting neurons in SON and PVN Osmo- and thirst receptors/centers in anterior hypothalamus Ascending pathways from ANS and brainstem
More informationPediatric Sodium Disorders
Pediatric Sodium Disorders Guideline developed by Ron Sanders, Jr., MD, MS, in collaboration with the ANGELS team. Last reviewed by Ron Sanders, Jr., MD, MS on May 20, 2016. Definitions, Physiology, Assessment,
More informationJUAN MIGUEL GIL R. ORTIZ, MD, FPCP, FPSN University of Santo Tomas Hospital
JUAN MIGUEL GIL R. ORTIZ, MD, FPCP, FPSN University of Santo Tomas Hospital HYPONATREMIA Hb 88 Creatinine 7 Na 130 K 5.8 Nonhypotonic Hyponatremia 1. Pseudohyponatremia 2. Presence of non-na effective
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 informationDiabetic Ketoacidosis
Diabetic Ketoacidosis Definition: Diabetic Ketoacidosis is one of the most serious acute complications of diabetes. It s more common in young patients with type 1 diabetes mellitus. It s usually characterized
More informationElectrolytes and other equally exciting topics
Electrolytes and other equally exciting topics Rebecca A. Snyder Summer School 2010 Why do we care? Why do we care? Why do we care? Torsades is bad. Because medical records cares even more. Because apparently
More informationHyponatremia and Hypomagnesemia
Hyponatremia and Hypomagnesemia Dre Kathy Ferguson,nephrologist Hyponatremia Salt and water imbalance Management Acute vs chronic Approach! How to make the correct diagnosis?! How to treat safely? Etiology!
More informationHyponatremia: A Review
Analytic Review Hyponatremia: A Review Mary Ansley Buffington, MD, JD 1 and Kenneth Abreo, MD 1 Journal of Intensive Care Medicine 2016, Vol. 31(4) 223-236 ª The Author(s) 2015 Reprints and permission:
More informationINTRAVENOUS FLUIDS PRINCIPLES
INTRAVENOUS FLUIDS PRINCIPLES Postnatal physiological weight loss is approximately 5-10% Postnatal diuresis is delayed in Respiratory Distress Syndrome (RDS) Preterm babies have limited capacity to excrete
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 informationElectrolyte imbalance พญ.วราภรณ เล ยวนรเศรษฐ หน วยโรคไต
Electrolyte imbalance พญ.วราภรณ เล ยวนรเศรษฐ หน วยโรคไต Content : Electrolyte Emergency!! Serum sodium Normal serum sodium: 135-145 meq/l Normal serum osmolality: 285-295 mosm/l Normal urine sodium: 10-20
More informationCCRN Review - Renal. CCRN Review - Renal 10/16/2014. CCRN Review Renal. Sodium Critical Value < 120 meq/l > 160 meq/l
CCRN Review Renal Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Sodium 136-145 Critical Value < 120 meq/l > 160 meq/l Sodium Etiology
More informationExtracellular fluid (ECF) compartment volume control
Water Balance Made Easier Joon K. Choi, DO. Extracellular fluid (ECF) compartment volume control Humans regulate ECF volume mainly by regulating body sodium content. Several major systems work together
More informationCCRN/PCCN Review Course May 30, 2013
A & P Review CCRN/PCCN Review Course May 30, 2013 Endocrine Anterior pituitary Growth hormone: long bone growth Thyroid stimulating hormone: growth, thyroid secretion Adrenocorticotropic hormone: growth,
More informationSAMSCA (tolvaptan) oral tablet
SAMSCA (tolvaptan) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy Coverage
More informationELECTROLYTES RENAL SHO TEACHING
ELECTROLYTES RENAL SHO TEACHING Metabolic Alkalosis 2 factors are responsible for generation and maintenance of metabolic alkalosis this includes a process that raises serum bicarbonate and a process that
More informationINTRAVENOUS FLUID THERAPY
INTRAVENOUS FLUID THERAPY PRINCIPLES Postnatal physiological weight loss is approximately 5 10% in first week of life Preterm neonates have more total body water and may lose 10 15% of their weight in
More informationAmjad Bani Hani Ass.Prof. of Cardiac Surgery & Intensive Care FLUIDS AND ELECTROLYTES
Amjad Bani Hani Ass.Prof. of Cardiac Surgery & Intensive Care FLUIDS AND ELECTROLYTES Body Water Content Water Balance: Normal 2500 2000 1500 1000 500 Metab Food Fluids Stool Breath Sweat Urine
More informationSym pt om s of "hyponat rem ia" Serum [Na + ] m Eq/ L: - Asymptomatic
Sym pt om s of "" Serum [Na + ] >130 m Eq/ L: - Asymptomatic Serum [Na + ] 120-130 m Eq/ L: - Nausea, vomiting - Fatigue, muscle cramps - Abdominal symptoms - Mild cognitive - Gait disturbances Serum [Na
More informationWorkshop CME 22 mars Pr Alain SOUPART Service de Médecine Interne Général Cliniques Universitaires Erasme, Bruxelles
Workshop CME 22 mars 2013 Pr Alain SOUPART Service de Médecine Interne Général Cliniques Universitaires Erasme, Bruxelles Overcorrection of chronic hyponatremia CASE REPORT I (1) Female 71 year Altered
More informationDisorders of Water Metabolism
Disorders of Water Metabolism Joshua M. Thurman and Tomas Berl 2 Introduction Disorders of water balance and serum Na ( S Na ) are very common in hospitalized patients [ 1 ]. In health, water balance and
More informationDisorders o f of water water Detlef Bockenhauer
Disorders of water Detlef Bockenhauer How do we measure water? How do we measure water? Not directly! Reflected best in Na concentration Water overload => Hyponatraemia Water deficiency => Hypernatraemia
More informationDOWNLOAD OR READ : SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE IN MALIGNANCY PDF EBOOK EPUB MOBI
DOWNLOAD OR READ : SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE IN MALIGNANCY PDF EBOOK EPUB MOBI Page 1 Page 2 syndrome of inappropriate secretion of antidiuretic hormone in malignancy
More informationSupplemental Information
FROM THE AMERICAN ACADEMY OF PEDIATRICS Supplemental Information SUPPLEMENTAL FIGURE 2 Forest plot of all included RCTs using a random-effects model and M-H statistics with the outcome of hyponatremia
More informationACID-BASE AND ELECTROLYTE TEACHING CASE Treating Profound Hyponatremia: A Strategy for Controlled Correction
ACID-BASE AND ELECTROLYTE TEACHING CASE Treating Profound Hyponatremia: A Strategy for Controlled Correction Richard H. Sterns, MD, John Kevin Hix, MD, and Stephen Silver, MD An alcoholic patient presented
More informationFluids, Electrolytes, and Nutrition
Fluids, Electrolytes, and Nutrition Leslie A. Hamilton, Pharm.D., BCPS, BCCCP University of Tennessee Health Science Center College of Pharmacy Knoxville, Tennessee Fluids, Electrolytes, and Nutrition
More informationObjectives. Objectives
Diagnosis & Management of Electrolyte & Acid Base Disturbances In the Acute Care Sophia Chu Rodgers, FNP, ACNP, FAANP, FCCM University of New Mexico Sandoval Regional Medical Center Albuquerque, New Mexico
More informationPhysiology of the body fluids, Homeostasis
Physiology of the body fluids, Homeostasis Tamas Banyasz The Body as an open system 1. Open system: The body exchanges material and energy with its environment 2. Homeostasis: The process through which
More informationNursing Process Focus: Patients Receiving Dextran 40 (Gentran 40)
Assess for presence/history of hypovolemia, shock, venous thrombosis. Assess vital signs: Hypovolemic shock secondary to surgery, burns, hemorrhage, other serious condition PT and PTT abnormalities Venous
More informationCalcium (Ca 2+ ) mg/dl
Quick Guide to Laboratory Values Use this handy cheat-sheet to help you monitor laboratory values related to fluid and electrolyte status. Remember, normal values may vary according to techniques used
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 informationPrinciples of Infusion Therapy: Fluids
Principles of Infusion Therapy: Fluids Christie Heinzman, MSN, APRN-CNP Acute Care Pediatric Nurse Practitioner Cincinnati Children s Hospital Medical Center May 22, 2018 Conflict of Interest Disclosure
More informationMetabolic Abnormalities in Critically Ill Patients
CHAPTER 66 Metabolic Abnormalities in Critically Ill Patients A. M. Bhagwati Introduction Critically ill patients have a unique set of problems, ranging from metabolic, endocrine, nutritional, respiratory
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 informationCorrection of hypervolaemic hypernatraemia by inducing negative Na + and K + balance in excess of negative water balance: a new quantitative approach
Nephrol Dial Transplant (2008) 23: 2223 2227 doi: 10.1093/ndt/gfm932 Advance Access publication 18 February 2008 Original Article Correction of hypervolaemic hypernatraemia by inducing negative Na + and
More informationSATURDAY PRESENTATIONS
Carolinas Chapter - American Association of Clinical Endocrinologists SATURDAY PRESENTATIONS 2018 Annual Meeting September 7-9, 2018 Kiawah Island Golf Resort Kiawah Island, SC This continuing medical
More informationDiagnostic Approach to the Patient with Hyponatremia and the Cause of Hyponatremia
Education Review Iran J Ped Vol 17. No 1, Mar 2007 Diagnostic Approach to the Patient with Hyponatremia and the Cause of Hyponatremia Farahnak Assadi * 1, MD 1. Pediatrics nephrologist, Professor of Pediatrics,
More informationPediatric Dehydration and Oral Rehydration. May 16/17
Pediatric Dehydration and Oral Rehydration May 16/17 Volume Depletion (hypovolemia): refers to any condition in which the effective circulating volume is reduced. It can be produced by salt and water loss
More informationChapter 26 Fluid, Electrolyte, and Acid- Base Balance
Chapter 26 Fluid, Electrolyte, and Acid- Base Balance 1 Body Water Content Infants: 73% or more water (low body fat, low bone mass) Adult males: ~60% water Adult females: ~50% water (higher fat content,
More informationCarolinas Chapter - American Association of Clinical Endocrinologists SATURDAY HANDOUTS Annual Meeting
Carolinas Chapter - American Association of Clinical Endocrinologists SATURDAY HANDOUTS 2018 Annual Meeting September 7-9, 2018 Kiawah Island Golf Resort Kiawah Island, SC This continuing medical education
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 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 information5/18/2017. Specific Electrolytes. Sodium. Sodium. Sodium. Sodium. Sodium
Specific Electrolytes Hyponatremia Hypervolemic Replacing water (not electrolytes) after perspiration Freshwater near-drowning Syndrome of Inappropriate ADH Secretion (SIADH) Hypovolemic GI disease (decreased
More informationMetabolism of water and electrolytes. 2. Special pathophysiology disturbances of intravascular volume and
Metabolism of water and electrolytes 1. Physiology and general pathophysiology Compartments of body fluids Regulation of volume and tonicity (osmolality) Combinations of volume and osmolality disorders
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 informationWorkshop on Hyponatremia. Pr Guy DECAUX Service de Médecine Interne Général Cliniques Universitaires Erasme, Bruxelles
Workshop on Hyponatremia Pr Guy DECAUX Service de Médecine Interne Général Cliniques Universitaires Erasme, Bruxelles CASE REPORT I A 70-year-old female patient is hospitalized because she fall on the
More informationHYPONATRAEMIA GUIDELINES
HYPONATRAEMIA GUIDELINES Na + < 130 mmol/l For all patients: Acute = onset < 48 hours Chronic = onset > 48 hours or not known Follow acute hyponatraemia flow chart on page 2 Follow chronic hyponatraemia
More informationFor more information about how to cite these materials visit
Author(s): Roger Grekin, 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 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 informationAcute Kidney Injury, Sodium Disorders, and Hypercalcemia in the Aging Kidney
Acute Kidney Injury, Sodium Disorders, and Hypercalcemia in the Aging Kidney Diagnostic and Therapeutic Management Strategies in Emergency Medicine Abdullah AlZahrani, MD a, Richard Sinnert, DO a, *, Joel
More informationCommon Metabolic Abnormalities DR. SANJAY PANDEYA MD. FRCPC.
Common Metabolic Abnormalities DR. SANJAY PANDEYA MD. FRCPC. Objectives 1. Review approach to hyponatremia Physiology & pathophysiology review Case-based common clinical questions Three-step process to
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 informationOncological emergencies. Harmesh Naik, MD. Medical Oncology Hope Cancer Clinic
Oncological emergencies Harmesh Naik, MD. Medical Oncology Hope Cancer Clinic Presentation to Internal Medicine GME resident physicians: October 24, 2013 Presentation goals Briefly review clinical presentation,
More informationHYPERNATREMIA/HYPONATREMIA
The following is material that is not all Dr. Ciorciari's original thoughts and not fully referenced to give credit to all information cited. Further this is not considered an authoritative source but
More informationInternational Journal of Biological & Medical Research
Int J Biol Med Res. 213; 4(1): 282-286 Int J Biol Med Res Volume 3, Issue 1, Jan 2 www.biomedscidirect.com BioMedSciDirect Publications Contents lists available at BioMedSciDirect Publications International
More informationWATER, SODIUM AND POTASSIUM
WATER, SODIUM AND POTASSIUM Attila Miseta Tamás Kőszegi Department of Laboratory Medicine, 2016 1 Average daily water intake and output of a normal adult 2 Approximate contributions to plasma osmolality
More informationCase Studies of Electrolyte Disorders ACOI Board Review Mark D. Baldwin D.O. FACOI
Case Studies of Electrolyte Disorders ACOI Board Review 2018 Mark D. Baldwin D.O. FACOI Disclosures None, just working for The Man Question 1 The first thing in evaluating a patient who has a disorder
More informationHyponatremia in Children with Acute Central Nervous System Diseases
Bahrain Medical Bulletin, Volume 30, No 1, March 2008 Hyponatremia in Children with Acute Central Nervous System Diseases Lamia M Al Naama, PhD* Meaad Kadhum Hassan, CABP** Entisar A. Al Shawi, MSc***
More informationAbout Salt, Sodium and Natremic Disorders
BASICS KERALA MEDICAL JOURNAL About Salt, Sodium and Natremic Disorders R Kasi Viswesaran Ananthapuri Hospital and Research Institute, Trivandrum - 695024* ABSTRACT Published on 26 th March 2009 The factors
More informationPROTRACTED ACUTE HYPERVOLEMIC HYPERNATREMIA UNMASKED AFTER VASOPRESSIN THERAPY, A CASE REPORT, REVIEW OF LITERATURE, AND PROPOSED ALGORITHMIC APPROACH
AACE Clinical Case Reports Rapid Electronic Articles in Press Rapid Electronic Articles in Press are preprinted manuscripts that have been reviewed and accepted for publication, but have yet to be edited,
More informationDisclaimer. Chapter 3 Disorder of Water, Electrolyte and Acid-base Professor A. S. Alhomida. Disorder of Water and Electrolyte
Disclaimer King Saud University College of Science Department of Biochemistry The texts, tables, figures and images contained in this course presentation (BCH 376) are not my own, they can be found on:
More informationCLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPONATRAEMIA Summary. Start. End. Key: Na + below normal range ( mmol/L) Symptomatic?
CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPONATRAEMIA Summary Key: General tes ED/MAU/SRU/Acute GP/Amb-Care GP/SWASFT In-patient wards Start Na + below normal range (135 145mmol/L) Refer to endocrinology
More informationFluid and electrolyte abnormalities. Melanie P. Hoenig (Derman) Associate Professor BIDMC
Fluid and electrolyte abnormalities Melanie P. Hoenig (Derman) Associate Professor BIDMC Disclosures: Editor, Kidney Self Assessment Program American Society of Nephrology Hyponatremia* Hypernatremia Hyperkalemia
More informationTreating the syndrome of inappropriate ADH secretion with isotonic saline
Q J Med 1998; 91:749 753 Treating the syndrome of inappropriate ADH secretion with isotonic saline W. MUSCH and G. DECAUX1 From the Department of Internal Medicine, Bracops Hospital, Brussels, and 1Department
More informationPublic Assessment Report. Scientific discussion. Natriumklorid Abcur (sodium chloride) SE/H/1443/01/MR
Public Assessment Report Scientific discussion Natriumklorid Abcur (sodium chloride) SE/H/1443/01/MR This module reflects the scientific discussion for the approval of Natriumklorid Abcur. The procedure
More informationI have no financial disclosures
Athina Sikavitsas DO Children's Emergency Services University of Michigan Discuss DKA Presentation Assessment Treatment I have no financial disclosures 1 6 Y/O male presents with vomiting and abdominal
More informationIX: Electrolytes. Sodium disorders. Specific Learning Objectives: Dan Henry, MD Clerkship Director University of Connecticut School of Medicine
IX: Electrolytes. Sodium disorders Dan Henry, MD Clerkship Director University of Connecticut School of Medicine Specific Learning Objectives: Knowledge Subinterns should be able to describe: a) The differentinal
More informationFor nearly 25 years, the treatment of hyponatremia
The Treatment of Hyponatremia Richard H. Sterns, MD, Sagar U. Nigwekar, MD, and John Kevin Hix, MD Summary: Virtually all investigators now agree that self-induced water intoxication, symptomatic hospital-acquired
More informationFLUIDS/ELECTROLYTES. Sahir Kalim, MD MMSc. Department of Medicine, Division of Nephrology, Massachusetts General Hospital Harvard Medical School
FLUIDS/ELECTROLYTES Sahir Kalim, MD MMSc Department of Medicine, Division of Nephrology, Massachusetts General Hospital Harvard Medical School Dr. Kalim has no potential conflicts of interest to disclose.
More informationTwo Little Water Cravers
Two Little Water Cravers Baby Mo (5mths/M) Chief complaint Repeated vomiting since 2 months old with poor weight gain PMH Gestation 40+6wks, BW 3.375kg Hx of fracture Rt clavicle at birth HbH disease on
More informationSodium Disorders In The Emergency Department: A Review Of Hyponatremia And Hypernatremia
Sodium Disorders In The Emergency Department: A Review Of Hyponatremia And Hypernatremia Abstract Identifying and correcting sodium abnormalities is critical, since suboptimal management potentially leads
More informationBody fluids. Lecture 13:
Lecture 13: Body fluids Body fluids are distributed in compartments: A. Intracellular compartment: inside the cells of the body (two thirds) B. Extracellular compartment: (one third) it is divided into
More information