lots of talking about salt

Yesterday we talked about approach to diagnosis of Hyponatremia

See the previous post on this : HERE

Also: take a lot at a review on hyponatremia.

Its important to note that volume depletion should results in HYPERnatremia. Hypovolemic hyponatremia is a result of replacing your loss with hypo-osmolar fluid (ie water or juice)

A special thanks to Dr. Amna Ahmed for reviewing the treatment of hyponatremia this morning as well as discussing HYPERnatremia.

HERE is a review on hypernatremia.

HypoNA

Yesterday we went through Hyponatremia, a WATER problem.

Here is the approach we went through:
1. Is the hypoNA real? (i.e. is there glucose or manitol on board, or is there high lipid or paraprotiens)
2. Is it acute and symptomatic- if so this should be treated immediate with 50cc/h of high concentration. Often this needs ICU 
3. What is the volume status? (hypo/hyper or euvolemic)

The urine lyte are the kidneys ways of telling you if its hypo or hypervolemic vs euvolemic and the physical exam tells you hypo or hyper. 

When treating with volume (for hypovolemia) or fluid restriction, the lytes should be checked every 4-6 hours to be sure there is no overcorrection (over 8 in 24 hour... we say over 12 to be safe). 

We discussed the dangers of the acute treatment of a chronic problem, and how to avoid complications like CPM with use of d5w or DDAVP if you exceed 0.5 meq/hr.
  (DDAVP is often given as 1-2mcg SC/IV) 

Here is the article discussing using DDAVP to prevent rapid correction.