Basic approach to: Hyponatremia Adley Wong, MHS PA-C
|
|
- Phebe Foster
- 5 years ago
- Views:
Transcription
1 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 Algorithm for evaluating hyponatremia Differentiating hypovolemic vs euvolemic hyponatremia Management of hyponatremia Objective: Hyponatremia is a water problem Hyponatremia is a water problem Excess water compared to sodium- regardless of volume status.
2 Normal response to hyponatremia Ability to excrete water is so great that water retention resulting in hyponatremia usually doesn t happen When your body senses that you have too much water this happens: Question When you drink 2 glasses of water, what happens to your serum osmolality? A. Increases B. Decreases Osmolality Osmolality= total concentration of solutes stuff in water. Normal Serum osm: Before water intake -Serum osm: After 2 cups of water intake -Serum osm: 275
3 Question After you drink 2 cups of water, your serum osmolality decreases. What happens to your anti-diuretic hormone (ADH) levels? A. Increase B. Decrease ADH= ANTI-diuretic hormone, helps retain water Decreases! Lack of ADH allows you to excrete free water. High serum osmolality Low serum osmolality There are 2 triggers for ADH Osmolality (amount of solute in water). When the plasma osmolality is low (more water than solute), ADH is off When the plasma osmolality is high (more solute than water), ADH is on. Volume Extreme Hypovolemia/Decrease in effective blood volume. During times of hypovolemia (ie. Shock), ADH kicks in
4 Objective: Physiology of Hyponatremia Remember hyponatremia is a WATER PROBLEM. One becomes hyponatremic when there is a problem with EXCRETION of free water Virtually all hyponatremic patients (exception of those with renal failure and primary polydipsia) have an excess of ADH. We care about hypoosmolar hyponatremia Cerebral edema! Symptoms of hyponatremia Serum sodium levels: Under 135 meq/l = Hyponatremia Below 125 meq/l --- Nausea and malaise Between 115 and 120 meq/l --- headache, lethargy and obtundatation.. Less than 115mEq/L-- More severe changes of seizures and coma Depends on chronicity: Chronic= few symptoms. Acute=more symptoms (esp acute <24hrs).
5 Objective: Algorithm for hyponatremia 1) Check serum osmolality. True hyponatremia is hypoosmolar Pseudohyponatremia Low plasma [Na+] with normal plasma osmolality Severe hyperlipidemia or hyperproteinemia Low plasma [Na+] with elevated plasma osmolality Hyperglycemia- Dilution, glucose causes water movement out of the cells and a reduction in the plasma Na+. Plasma Na+ concentration fall 1 meq/l for every 62mg/dL rise in serum glucose (above 100mg/dL). Algorithm 1) Check serum osmolality. True hyponatremia is hypoosmolar (RELATIVE more water than solute) 2) Check volume status, urine sodium and urine osm Hypovolemic Hyponatremia Euvolemic Hyponatremia Hypervolemic Hyponatremia
6 Volume status can be challenging Evaluate: Vital signs Orthostatic vital signs Jugular venous pressure, skin turgor, mucous membranes, peripheral edema Blood urea nitrogen Uric acid Objective: Differentiating between hypovolemia and euvolemia Hypovolemic Euvolemic Signs/Symptoms: Dry mucous membranes, vomiting, diarrhea, tachycardia, orthostatic. Labs: Elevated BUN/Cr ratio >20:1, Urinary sodium<20 meq/l, FENA<1% or FEUREA<35%, elevated uric acid Signs/Symptoms: Absence of hypovolemia Labs: Normal BUN/Cr ratio. Urine sodium>20 meq/l ****Urine sodium may not always correlate with volume status (i.e. diuretic use can elevate urine sodium; low-salt diet can artificially lower urine sodium) Hypovolemic hyponatremia Fluid losses from GI tract, kidneys or skin RX: Isotonic saline
7 Euvolemic Hyponatremia Volume status is normal Low osmolality (true hyponatremia) = expect ADH to be OFF = expect dilute urine (low urine osm, <100 mosm per kg) Euvolemic hyponatremia Urine osm >100 mosm per kg Syndrome of inappropriate antidiuretic hormone secretion (SIADH), hypothyroidism, adrenal insufficiency, drug use Urine osm <100 mosm per kg Primary polydipsia, low solute intake (beer potomania syndrome) Variable urinary osm Reset osmostat RX: Fluid (Free water) restriction. Treat underlying condition. Hypervolemic hyponatremia Volume overloaded states (Systolic Heart failure, cirrhosis, hypoalbuminemia) Intravascular volume depletion = increased ADH Urine sodium <20 meq/l RX: Fluid & sodium restriction, diuresis Renal failure- kidneys can t excrete free water efficiently (not ADH) Urine sodium >20 meq/l RX: Fluid & sodium restriction, dialysis
8 RECAP: Check serum osm Check volume status// urine osm and urine sodium Hypovolemic hyponatremia RX: Isotonic saline Euvolemic hyponatremia RX: Fluid (free water) restriction, treat underlying condition Hypervolemic hyponatremia RX: Fluid (free water) and sodium restriction, Diuresis, treat underlying condition Case Applying the hyponatremia algorithm to determine the ETIOLOGY of hyponatremia Ms. D is a 85 y/o F Zumba instructor with PMH breast cancer who presents for an evaluation of hyponatremia. Case HPI: Hyponatremia 128 in June and 127 in July. Baseline serum sodium meq/l from No new meds Drinks 4-5 ten ounce water bottles daily. No changes in weight. Good appetite. SBP in low 100s which is baseline for her. Complains of fatigue over the past few months but still exercising with Zumba daily.
9 Case VS: Afebrile, BP 90/50 (SBP low 100s normal for her), not orthostatic, HR 70, RR 18, Room Air Pertinent positives: Gen: Thin NAD HEENT: Moist mucous membranes Neck: No JVD CVS: RRR, no m/r/g Lungs: CTAB GI: Soft, NT/ND Extremities: No edema Skin: Normal skin turgor Labs: Serum osm- 270, Urine osm of 192, Urine sodium 24 Na- 127/ K- 5.4 /Bicarb- 29/ BUN- 14/Cr- 0.64/ Glucose 110/ TSH normal; cortisol normal Case: What is the differential? Primary polydipsia Renal failure Hypothyroidism Adrenal insufficiency SIADH Medication induced Case: Applying the algorithm 1) Serum osm- 270, true hyponatremia 2) Volume status: Euvolemic BP is 90/50 but normal for her. She is not orthostatic. Not tachycardic. JVP is not elevated. Normal skin turgor and moist mucous membranes. No peripheral edema. BUN<20:1. Unremarkable uric acid levels.
10 Case: Working up euvolemic hyponatremia Check urine sodium and urine osm to help clarify differential after volume status Urine sodium is 24 (expect >20 in euvolemia) Urine osm of 192 (expect <100, seems inappropriately high) If euvolemic & Urine osm >100 mosm per kg DDx: SIADH, hypothyroidism, adrenal insufficiency, drug use Case: What is the highest on your differential? Primary polydipsia (based on algorithm and history, expect urine osm <100) Renal failure (normal Cr) Hypothyroidism (normal TSH of 1.49) Adrenal insufficiency (normal AM cortisol) SIADH Medication induced (reviewed medications) SIADH Characterized by nonphysiologic release of ADH (ie. Not due to usual stimuli such as hyperosmolality or hypovolemia)
11 Etiology SIADH can be produced by enhanced hypothalamic secretion, ectopic (nonhypothalamic) hormone production, the potentiation of ADH effect or the administration of exogenous ADH. Causes of SIADH Increased hypothalamic production of ADH Neuropsychiatric disorders/cns Infections meningitis, encephalitis, abscess, herpes zoster Vascular: thrombosis, subarachnoid or subdural hemorrhage, Neoplasma: primary or secondary Psychosis Pulmonary disease may be from decrease pulmonary venous return leading to volume receptors Pneumonia: viral, bacteria, or fungal TB Acute respiratory failure Other: Asthma, atelectasis, pneumothorax Postoperative patient inappropriate ADH secretion is common and persists for 2 5 days. Appears to be mediated by pain afferents Severe nausea Drugs: SSRIs, thiazides Causes of SIADH Ectopic (nonhypothalamic production of ADH) Carcinoma: small cell of lung, bronchogenic, duodenum, pancreas, thymus, olfactory, neuroblastoma Potentiation of ADH effect IV cyclophosphamide
12 Diagnosis of SIADH Summary Hyponatremic. Hypoosmolar (Serum osm low) Euvolemic. Ruled out for other causes of Euvolemic Hyponatremia. Urine osm inappropriately high (>100 mosmol/kg) Urine sodium normal (usually greater than 20 meq/l) Hypouricemia Treatment for this patient For our patient with SIADH, what would be the appropriate management? A. Give normal saline B. Fluid (free water) restriction to 0.8L C. Give salt tablets Treatment for this patient For our patient with SIADH, what would be the appropriate management? A. Give normal saline- NO. She will keep more water and serum sodium will fall B. Fluid (free water) restriction to 0.8L daily- YES C. Give salt tablets- MAYBE
13 Major treatment Hypovolemic Hyponatremia Isotonic Saline Euvolemic Hyponatremia Fluid (free water) restriction, treat underlying condition Hypervolemic Hyponatremia Fluid (free water) and sodium restriction, Diuresis, treat underlying condition For AKI, fluid/sodium restriction and possible dialysis Treatment: Rate of Correction Why worry? Overly rapid correction can lead to cerebral dehydration and cause osmotic demyelination Paraparesis, dysarthria, dysphagia, coma, seizures Those at greatest risk are individuals with chronic hyponatremia (brain cells have adapted to hyponatremia) Treatment: Goals Chronic Hyponatremia/asymptomatic: Rate of correction: <10-12 meq/l in first 24hrs (<0.5 meq/l per hour) and <18 meq/l in 48hrs. Acute Hyponatremia/symptomatic: Risk of untreated hyponatremia and cerebral edema is greater than the potential harm of overly rapid correction Hypertonic 3% saline infused at a rate of 0.5 to 2 ml/kg/hour until symptoms resolve Increase of 4-6 meq/l usually sufficient to reduce symptoms Should NOT exceed 10-12mE/L in first 24hrs (same as above) Loop diuretics may be used if concurrent volume overload
14 Thank you! Special Thanks to: Dr. Pedram Fatehi, Dr. Tara Chang and Shira Simpson PA-C! Questions? Sources Rose, Burton David. (2001). Clinical Physiology of Acid-Base and Electrolyte Disorders. New York: McGraw-Hill. Gilbert, Scott J., et al. (2014). National Kidney Foundation s Primer on Kidney Diseases. Philadelphia: Elsevier. Braun, M.M., Barstow, C.H., Pyzocha, N.J. (2015). Diagnosis and Management of Sodium Disorders: Hyponatremia and Hypernatremia. Am Fam Physician. 2015; 91 (5): Retrieved from: Treatment of hyponatremia: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and reset osmostat. UptoDate, 10, June 2018.
Disorders of water and sodium homeostasis. Prof A. Pomeranz 2017
Disorders of water and sodium homeostasis Prof A. Pomeranz 2017 Pediatric (Nephrology) Tool Box Disorders of water and sodium homeostasis Pediatric Nephrology Tool Box Hyponatremiaand and Hypernatremia
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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 informationSerum [ Serum Na] = 128 meq/l Question~ why Question~ wh edema?
Objectives Case Summary 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
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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 informationSamsca. Samsca (tolvaptan) Description
Subject: Samsca Page: 1 of 5 Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Last Review Date: September 20, 2018 Samsca Description Samsca (tolvaptan)
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 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 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 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 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 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 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 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 informationTaking Tolvaptan with a grain of salt. Jia (Shermaine) Ngo LMPS Pharmacy Resident October 7, 2016
Taking Tolvaptan with a grain of salt Jia (Shermaine) Ngo LMPS Pharmacy Resident 2016-2017 October 7, 2016 1 Learning Objectives Define Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
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 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 informationHypo/Hypernatremia. Stuart L. Goldstein MD. Director, Center for Acute Care Nephrology Cincinnati Children s Hospital
Hypo/Hypernatremia Stuart L. Goldstein MD Director, Center for Acute Care Nephrology Cincinnati Children s Hospital Objectives Understand Fluid cellular shifts Understand maintenance fluid and calculations
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 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 informationEstimation of Body Fluid Volume by Bioimpedance Spectroscopy in Patients with Hyponatremia
Original Article http://dx.doi.org/10.3349/ymj.2014.55.2.482 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 55(2):482-486, 2014 Estimation of Body Fluid Volume by Bioimpedance Spectroscopy in Patients
More informationDiseases of the Adrenal gland
Diseases of the Adrenal gland Adrenal insufficiency Cushing disease vs syndrome Pheochromocytoma Hyperaldostronism What are the layers of the adrenal gland?? And what does each layer produce?? What are
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 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 informationNot all Hyponatremia is a Saline Deficiency SIADH in the Real World
Not all Hyponatremia is a Saline Deficiency SIADH in the Real World Mark D. Baldwin D.O., FACOI Professor and chair of the Department of Internal Medicine Pacific Northwest University of Health Sciences
More informationAdrenocortical Insufficiency: Addison's Disease
280 PHYSIOLOGY CASES AND PROBLEMS Case 49 Adrenocortical Insufficiency: Addison's Disease Susan Oglesby is a 41-year-old divorced mother of two teenagers. She has always been in excellent health. She recently
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 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 informationORIGINAL ARTICLE HYPONATREMIA IN ELDERLY *Dr. T. Prabhu. Annamalai University, Annamalainagar , Tamilnadu, India
Available online at www.journalijmrr.com INTERNATIONAL JOURNAL OF MODERN RESEARCH AND REVIEWS IJMRR ISSN: 2347-8314 Int. J. Modn. Res. Revs. Volume 2, Issue 10, pp 325-332, October, 2014 ORIGINAL ARTICLE
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 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 informationDr. Carlos Fernando Estrada Garzona. Departamento de Farmacología Universidad de Costa Rica
Dr. Carlos Fernando Estrada Garzona Departamento de Farmacología Universidad de Costa Rica OBJETIVOS FISIOLOGIA LIQUIDOS CORPORALES SOLUCIONES PARENTERALES PRINCIPIOS DE FLUIDOTERAPIA CRISTALOIDE VS COLOIDE
More informationIntravenous Fluids: In the ER and on the floor. MEValletta,, MD August 4, 2005 Resident Core Conference Lecture Series
Intravenous Fluids: In the ER and on the floor MEValletta,, MD August 4, 2005 Resident Core Conference Lecture Series Objectives Understand appropriate fluid resuscitation Understand appropriate fluid
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 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 informationAdrenal Gland Disorders
1 Adrenal Gland Disorders Adrenal cortex steroid hormones (corticosteroids) 1. Glucocorticoids Regulate metabolism and blood glucose Critical to physiologic stress response 2. Mineralocorticoids Regulate
More informationStudy of incidence of medical neurological causes of hyponatremia
Original article: Study of incidence of medical neurological causes of hyponatremia *Dr Harishchandra R Chaudhari, **Dr Yogesh P Bade *Assistant Professor, Department of Medicine, Dr DY Patil Medical College
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 informationDr. Rezzan Khan Consultant Nutritionist Shifa International Hospital
Dr. Rezzan Khan Consultant Nutritionist Shifa International Hospital Concept of Fluid & Electrolyte Balance Body fluid and electrolyte homeostasis Differentiate between hypovolemic, euvolemic, and hypervolemic
More informationNormal and Abnormal Water Balance: Hyponatremia and Hypernatremia *
An In-Depth Look: NORMAL AND ABNORMAL WATER BALANCE CE Article #1 Normal and Abnormal Water Balance: Hyponatremia and Hypernatremia * Katherine M. James, DVM, PhD, DACVIM Veterinary Information Network
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 informationCase Report Development of Severe Hyponatremia due to Salt-Losing Nephropathy after Esophagectomy for Esophageal Cancer
Case Reports in Medicine Volume 009, Article ID 183, pages doi:10.1155/009/183 Case Report Development of Severe Hyponatremia due to Salt-Losing Nephropathy after Esophagectomy for Esophageal Cancer Katsunobu
More informationBEFORE the session. Sodium & Water Assessment & Therapeutics. LMPS Residents
BEFORE the session 1. Get Loewen s Sodium & Water Assessment & Therapeutics 1-pager at www.peterloewen.com/made 2. Read McGee S, Abernethy WB, Simel DL. Is this patient hypovolemic? JAMA 1999;281:1022-9
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 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 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 information75 year old woman with Hyponatremia. Sharon H. Chou, MD Endorama September 13, 2012
75 year old woman with Hyponatremia Sharon H. Chou, MD Endorama September 13, 2012 History of Present Illness 75 yo woman who was previously healthy until the past month when she had recurrent admissions
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 informationFLUID THERAPY: IT S MORE THAN JUST LACTATED RINGERS
FLUID THERAPY: IT S MORE THAN JUST LACTATED RINGERS Elisa M. Mazzaferro, MS, DVM, PhD, DACVECC Cornell University Veterinary Specialists, Stamford, CT, USA Total body water constitutes approximately 60%
More information2018/6/7 APSN/JSN CME Course Division of Nephrology St. Luke s International Hospital Raku Son M.D., PGY6
2018/6/7 APSN/JSN CME Course 2018 Division of Nephrology St. Luke s International Hospital Raku Son M.D., PGY6 Case1 77F Left leg pain Na 112 Case2 39M Seizure Na 117 Case3 73M General malaise Na 120 Case1
More informationThe Treatment of Acute Hyponatremia with Tolvaptan
ISSN: 2380-5706 Volume 2, Issue 1, 5 Pages Research Article What is Known and Objective Open Access The Treatment of Acute Hyponatremia with Tolvaptan Marilyn Novell Bulloch, Pharm.D., BCPS, FCCM, Aimee
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 informationConsultant emergency medicine Security Forces Hospital Ministry of Interior KSA
Consultant emergency medicine Security Forces Hospital Ministry of Interior KSA Why Electrolytes are Important? IMMEDIATE LIFE THREAT. You can Save or KILL the patient fixing it. USEFUL CLUE to the UNDERLYING
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 informationNeuroendocrine challenges following hemispherectomy
Neuroendocrine challenges following hemispherectomy Philip S. Zeitler MD. PhD Professor and Head Section of Endocrinology Children s Hospital Colorado University of Colorado Anschutz Medical Campus I am
More information