Hyponatremia management involves identifying the type and treating the underlying cause. There are three main types - hypotonic, isotonic, and hypertonic hyponatremia. Hypotonic hyponatremia is the most common type and can be further classified as hypovolemic, euvolemic, or hypervolemic based on volume status. Euvolemic hypotonic hyponatremia is often caused by SIADH or poor solute intake. Treatment aims to restrict free water intake and increase free water excretion by restricting fluids, increasing solute intake, or using medications. The rate of sodium correction is important to avoid complications and should generally not exceed 10-12 m
Hyponatremia is a common electrolyte disorder in diverse fields of medicine. A sound understanding of Physiology is essential for its management. Real life clinical examples are described
Hyponatremia is a common electrolyte disorder in diverse fields of medicine. A sound understanding of Physiology is essential for its management. Real life clinical examples are described
The following materials were presented in front of audience from R/D PT. Telkom Indonesia on 03 March 2016. It was part of LPPM Writing Tutorial in-house training.
From a course by Christine Greenhalgh, Oxford University. Released as open courseware as part of the TRUE project. For more labour economics materials, go to http://www.economicsnetwork.ac.uk/labour
Asian Physics Symposium 2015
Institut Teknologi Bandung, 19-21 Aug 2015
Author: Dasapta Erwin Irawan, Prihadi Sumintadireja, Ahmad Darul, Anggita Agustin, Arif Nurrochman, and Deny Juanda Puradimaja
Preliminary hydrogeological study of the spring belt at three stratovolcanoes has been carried out to predict major hydrogeological boundaries in the stratovolcano system. We used hydrogeological map and 2D finite-element, 2D, computer program to fit the groundwater flow net with the location of spring belt. The spring belt ranges from 250 to 650 masl at Gunung Ciremai, 500-750 masl at Gunung Gede, and 200-400 masl at Gunung Karang-Pulasari. In the first experiment, we set the geological boundaries and topographical features as fixed boundary, which returns slightly different spring belt in the model. Therefore we need to adjust the geological properties to be able to match the spring belt position. Several scenarios using different thickness and permeability have been applied to the model. We find rock thickness has more control to groundwater flow net, where as permeability values have less sensitive role to such flow net. Each volcanoes showed distinct variations of two parameters has occurred on many directions, controlling radial groundwater flow with different hydraulic gradient. Role as recharge area has not applied to entire part of highlands, because of impermeable lava. Anomalies needed careful on-field focussing to get the complete picture of hydrogeology system of strato volcano.
Follow below steps:
1. Pour the ground to the pot - about 1/4 of the pot.
2. Take out the flower, which you want to plant from the pot.
3. Put the flower to the new pot.
4. Pour the ground to the end of pot.
5. Tamp down the ground around the flower.
6. Water the flower.
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The European Commission support for the production of this publication does not constitute endorsement of the contents which reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein.
Managing Metadata for Science and Technology Studies: the RISIS caseRinke Hoekstra
Presentation of our paper at the WHISE workshop at ESWC 2016 on requirements for metadata over non-public datasets for the science & technology studies field.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
3. Normal water balance
Normal water intake(1-1.5 L/d)
Intracellular Extracellular
Compartment compartment
28 L 14 L
42 L TBW
60% of body
weight
Fixed water excretion
Stool Sweat Lungs
0.1 L/d 0.1 L/d 0.3 L/d
Total insensible losses
0.5 L/d
Water
Of
Cellular
Metabol
0.3-0.5
L/d
Variable water excretion
Kidney
Total urine output
1-1.5 L/d
Water
intake
Water
excretion
ADH
12. Hypotonic hyponatremia
(Vol status indeterminate)
Urine Na <30 :
Respond to 0.9 NS
Volume depleted
Urine Na > 30 :
No response to 0.9 NS
Likely to have SIADH
14. SIADH
Criteria for diagnosis:
P osm <275 mOsm/kg
U osm >100 mOsm/kg
Clinical euvolemia
Urine Na > 30mmol/L while on normal salt intake
Normal thyroid, adrenal and renal functions
Inappropriately elevated AVP levels in 85-90%
17. Euvolemic Hypotonic hyponatremia
Poor solute Intake
Beer Potomania, Tea Toast syndrome
Urine Volume =
Normal Urinary Electrolytes Normal Urinary Urea
Na+ , K+ = 150 + 50 = 200 Catabolism= 75-100
Accompanying anions= 200 Diet ~50 mM/10 gm of dietary protein
Total 400 mM/day Total 400-500 mM/day
Urinary solute excretion
Urinary Osmolality
Clinical setting of low solute intake:
- Alcoholism (Beer Potomania)
- Anorexia (Tea and Toast Diet)
Urinary solute excretion
in person on normal diet-
800-900 mM/day
18. Euvolemic Hypotonic hyponatremia
Poor solute Intake
Treatment
1. Increase solute intake –
• High protein diet
• Salt tablets or high dietary salt
• Urea
2. Fluid restriction
19.
20. Hospital acquired Hyponatremia
Virtually every hospitalized patient has
potential stimulus for AVP excess
Administration of hypotonic fluid with excess
AVP are at risk for Hyponatremia
Chung HM et al, Arch Inter Med 2002
21. Hospital acquired hyponatremia
• Ringer’s Lactate (Sodium 77) is hypotonic
and can produce hyponatremia
• No justification for Ringers lactate in post op
period
• Administration of 0.9 saline is safe
• No reports of 0.9 Saline causing neurological
complications of hyponatremiaSteele A et al, Ann Intern Med 1997
Moritz ML et al, J Am Soc Nephrol 2005
28. Extensive data suggest that the serum sodium
should be raised by no more than 10 mEq/L over 24
hours. Correction by 6 mEq/L in 24 hours has been
dubbed the "rule of sixes."The rule of sixes is as
follows: "Six-a-day makes sense for safety. Six in 6
hours for severe symptoms and stop."
29. Acute Hyponatremia:
Less than 48 hrs
Neurologic symptoms due to brain edema
Rapid correction well tolerated
Chronic Hyponatremia:
More than 48 hrs or unknown time
Mild brain edema (<10%)
Sensitive to Na correction rate
Aim to increase Na by 10% (not more than 12 in 24
hrs)
30. How long has hyponatremia been present?
Does the patient have symptoms?
Does the patient have risk factors for
development of neurologic complications?
31. Monitoring of patients
Volume status
Daily weight
Frequent Serum Na, K
Plasma Osmolality
Urine Na, K, osmolality
Strict Input and Output
32. Basic concept
Free water intake << Free water output
AND
Na, K intake >> Na, K output
Needed Info:
Serum Na , osmolality
Urine Na, K, Osmolality
Strict Input/ Output
Rate of correction
33. Hyponatremia
Chronic
AsymptomaticSymptomatic
Long term
management
Treat etiology
Water restriction
Demeclocycline
Some immediate correction
Hypertonic saline
+ Furosemide
Change to water restriction
Frequent serum & urine
electrolytes
Do not exceed 12 meq/l/d
Emergency
Hypertonic
saline+
furosemide
Acute <48 hrs Chronic>48 hrs
No immediate
Correction needed
Thurman et al,Therapy in nephrology and
35. Treatment based on neurological symptoms and
not on Sodium
Needs aggressive management with 3%NaCl
No role of fluid restriction alone
Treatment should precede any neuroimaging
Treatment in monitored setting
Sodium levels measured every 2 hours
36. Impending herniation: Sz, resp arrest,, obtundation,
Decorticate posturing, dilated pupils:
100 ml of 3% NaCl as a bolus over 10 min to rapidly
reverse brain edema.
Repeat bolus as required till symptoms improve
Encephalopathy: Headache, N/V, Altered mental status:
3% NaCl @ 50-100 ml/hr
Calculating 3% saline rate:
Weight in kg x desired rate of increase in Serum Na
37. Monitor [Na] every 2-4 hrs
Stop active correction when appropriate end point is
reached:
Patient becomes asymptomatic
Safe Na levels reached (generally 120)
Total correction 12 mmol in 24 hrs or 18-20 mmol
in 48 hrs
Complete rest of correction with - fluid restriction
38. Attend to underlying cause
No immediate correction needed
Fluid restriction
Urine Na + K
Plasma Na
Recommended water intake
>1 < 500 ml/day
-1 500 to 700 ml/day
< 1 < 1000 ml/day
D Ellison, T Berl. NEJM 2007;356:2064-72
39. Treatment Mechanism Dose Advantage Limitations
Fluid
restriction
Decreases
availability of free
water
Variable Effective
Inexpensive
Non compliance
Encourage dietary
salt and protein
Solutes required
for free water
excretion
Variable
Demeclocycline ↓ ADH response 300-600 mg BID Effective
Unrestricted
water intake
Nephrotoxic,
Polyuria,
Photosensitive
V-2 Receptor
antagonist -
Conivaptan
Antagonize ADH
receptor
20-40 mg/day
IV (Vaprisol)
Effective Available only as
IV
41. Take home message
Hyponatremia –a common, life threatening
problem
In presence of ADH concentrated urine is formed
Treatment – Basic concept:
Free water Input << Free water Output
Na+K Input >> Na+K Output
Step wise evaluation important