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This document discusses hyponatremia, defined as a serum sodium concentration less than 135 meq/l. It covers the clinical features and causes of hyponatremia including hypovolemic, hypervolemic, and euvolemic types. Treatment depends on the severity and chronicity of hyponatremia, targeting gradual correction to avoid complications. Acute severe cases may require rapid correction with hypertonic saline while chronic cases require fluid restriction and avoidance of rapid sodium increases. The key is individualizing treatment based on the underlying etiology and symptoms.
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This document discusses hyponatremia, defined as a serum sodium level below 135 mEq/L. Hyponatremia can be hypovolemic, hypervolemic, or euvolemic based on total body water and sodium levels. Causes include sodium loss from the kidneys, adrenal insufficiency, SIADH, and liver or heart failure. Symptoms depend on severity and chronicity, ranging from headache to seizures or coma. Evaluation involves assessing volume status and electrolytes. Treatment involves correcting underlying causes and normalizing sodium levels gradually to avoid osmotic demyelination.
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This document discusses hyponatremia, defined as a sodium level below 135 mEq/L. It describes the fluid compartments in the body under normal conditions and with hyponatremia. Causes of hyponatremia include excessive water intake, syndrome of inappropriate antidiuretic hormone secretion, and liver or kidney failure. Symptoms range from nausea and vomiting to seizures and coma. Severe hyponatremia below 115 mEq/L may warrant emergency treatment to correct the sodium level by no more than 1 mEq/L/hour. The document provides extensive details on the causes, diagnosis, and treatment of hyponatremia.
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This document discusses hyponatremia, defined as a serum sodium level below 135 mEq/L. Hyponatremia can be hypovolemic, hypervolemic, or euvolemic based on total body water and sodium levels. Causes include sodium loss from the kidneys, adrenal insufficiency, SIADH, and liver or heart failure. Symptoms depend on severity and chronicity, ranging from headache to seizures or coma. Evaluation involves assessing volume status and electrolytes. Treatment involves correcting underlying causes and normalizing sodium levels gradually to avoid osmotic demyelination.
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1. Hyponatremia is defined as a serum sodium below 135 mmol/L and is the most common electrolyte disorder seen in clinical practice.
2. The document discusses the etiologies and pathophysiologies of hyponatremia including hypovolemic, euvolemic, and hypervolemic causes.
3. Treatment of hyponatremia depends on the severity and chronicity of the low sodium levels and involves restricting water intake, sodium supplementation, or in severe cases, hypertonic saline therapy. The goal is to correct sodium levels slowly to avoid osmotic demyelination syndrome.
Neurology of electrolyte imbalance
This document discusses various electrolyte abnormalities including sodium, potassium, calcium and magnesium disorders. It provides definitions, epidemiology, causes, clinical features and treatment approaches for conditions like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypercalcemia and hypocalcemia. Specifically, it outlines the evaluation and management of sodium disorders like hyponatremia and hypernatremia due to various volume status abnormalities.
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Approach to edema
Edema is swelling caused by excess fluid trapped in your body's tissues. Although edema can affect any part of your body, you may notice it more in your hands, arms, feet, ankles and legs.
Edema can be the result of medication, pregnancy or an underlying disease — often congestive heart failure, kidney disease or cirrhosis of the liver.
Taking medication to remove excess fluid and reducing the amount of salt in your food often relieves edema. When edema is a sign of an underlying disease, the disease itself requires separate treatment.
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- Metabolic acidosis occurs when there is an excess of fixed or exogenous acids in the blood, accompanied by a drop in plasma bicarbonate concentration.
- It is classified based on calculations of anion gap, delta ratio, and osmolar gap. An increased anion gap suggests retained fixed acids while a normal anion gap acidosis involves bicarbonate loss.
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Hyperkalemia is defined as a serum potassium level greater than 5.5 mmol/L. The severity can range from mild (<6.0 mmol/L) to moderate (6.0-7.0 mmol/L) to severe (7.0-8.0 mmol/L potentially causing ECG changes and above 8.0 mmol/L potentially causing cardiac arrest). Management involves stabilizing the membrane potential with calcium salts for ECG changes, shifting potassium into cells with insulin and glucose, removing potassium from the body with resins or dialysis, and preventing further increases by reviewing medications and diet.
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- Sodium is the major ion in extracellular fluid and regulates plasma volume, membrane potential, and glucose/amino acid transport. Renal excretion tightly regulates sodium levels.
- Hyponatremia is classified based on serum osmolality as normal, high, or low. Causes and management depend on volume status and underlying condition. Chronic hyponatremia requires slow correction to avoid osmotic demyelination syndrome.
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This document discusses the clinical manifestations of renal disease that can help detect underlying kidney disorders. Symptoms include disturbances in urination like frequency, pain, retention, incontinence, and nocturia. Changes in urine such as amount, appearance, and presence of blood, protein, or casts are also discussed. Pain symptoms can include flank pain, ureteric colic, or suprapubic discomfort. General symptoms include fever, swelling, fatigue, itching, and pallor. Detecting these clinical signs is important for identifying renal abnormalities.
Hyponatremia
This document discusses hyponatremia, including definitions, causes, symptoms, evaluation and treatment. It defines hyponatremia as a serum sodium concentration <135 mmol/L. Evaluation involves assessing volume status, serum and urine osmolality and sodium levels. Causes include SIADH, hypothyroidism and medications. Treatment depends on severity and chronicity of hyponatremia and involves fluid restriction, oral salts or vaptans. Acute severe hyponatremia is treated with intravenous 3% saline while chronic asymptomatic hyponatremia can be managed with fluid restriction and oral salts.
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1. Hyponatremia is defined as a serum sodium below 135 mmol/L and is the most common electrolyte disorder seen in clinical practice.
2. The document discusses the etiologies and pathophysiologies of hyponatremia including hypovolemic, euvolemic, and hypervolemic causes.
3. Treatment of hyponatremia depends on the severity and chronicity of the low sodium levels and involves restricting water intake, sodium supplementation, or in severe cases, hypertonic saline therapy. The goal is to correct sodium levels slowly to avoid osmotic demyelination syndrome.
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Dr. Arun Karmakar presented on hyponatremia. Hyponatremia is defined as a serum sodium below 135 mmol/L and is the most common electrolyte disorder. It is clinically important because acute severe hyponatremia can cause morbidity and mortality, and outcomes are worse in hyponatremic patients with underlying diseases. Hyponatremia can be hypovolemic, euvolemic, or hypervolemic depending on water and sodium levels. Treatment depends on the severity and cause of hyponatremia, with aggressive correction for symptomatic cases and slower correction for chronic cases to avoid osmotic demyelination syndrome.
Hyponatremia
1. Hyponatremia is defined as a serum sodium level below 135 mEq/L and can be classified as mild, moderate, or severe based on the serum sodium concentration.
2. Signs and symptoms range from nausea and malaise in mild cases to seizures and coma in severe cases and depend on the severity and chronicity of hyponatremia.
3. Causes of hyponatremia include excessive water intake, syndrome of inappropriate antidiuretic hormone secretion, and conditions affecting sodium balance such as liver disease, heart failure, and use of certain medications.
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Hyponatremia is defined as a low serum sodium concentration and can be acute (<48 hours) or chronic (>48 hours). It is clinically important because acute severe hyponatremia can cause morbidity and mortality, and adverse outcomes are higher in hyponatremic patients. Overly rapid correction of chronic hyponatremia can cause severe neurological deficits or death. Hyponatremia can be hypervolemic, hypovolemic, or euvolemic based on water and sodium levels. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common cause of euvolemic hyponatremia and results from excess vasopressin secretion. Treatment depends on
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Hyponatremia, defined as a plasma sodium concentration below 135 mM, is a common electrolyte disorder seen in up to 22% of hospitalized patients. It is usually caused by water retention due to increased secretion of antidiuretic hormone (ADH) and/or increased renal sensitivity to ADH combined with free water intake. Hyponatremia can be categorized as hypovolemic, euvolemic, or hypervolemic based on clinical history and volume status. Treatment involves correcting the underlying cause and raising the plasma sodium concentration slowly to avoid complications like osmotic demyelination syndrome which can result from overly rapid correction.
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This document discusses hyponatremia and hypernatremia. It begins by explaining sodium regulation and the physiological basis of serum sodium concentration. It then defines and describes the types and causes of hyponatremia, including hypovolemic, euvolemic, and hypervolemic hyponatremia as well as pseudo hyponatremia. Specific conditions like SIADH are explained in detail. The clinical features, diagnosis, and treatment of hyponatremia are outlined. Hypernatremia is also defined and its causes such as net water loss or hypertonic sodium gain are summarized. The clinical features of hypernatremia are said to be predominantly neurologic.
hyponatremiaandhypernatremia-160310202741.pdf
This document discusses hyponatremia and hypernatremia. It begins by explaining sodium regulation and the physiological basis of serum sodium concentration. It then defines and describes the types and causes of hyponatremia, including hypovolemic, euvolemic, and hypervolemic hyponatremia as well as pseudo hyponatremia. Specific conditions like SIADH are explained in detail. The clinical features, diagnosis, and treatment of hyponatremia are outlined. Hypernatremia is also defined and the causes of net water loss and hypertonic sodium gain are listed. The clinical features of hypernatremia are said to be predominantly neurologic.
Electrolyte disorders
Sodium, potassium, and other electrolyte disorders can cause significant neurological and cardiac issues. Low sodium (hyponatremia) can cause symptoms ranging from nausea to seizures depending on severity. Treatment involves restricting water intake and using isotonic fluids or hypertonic saline. High sodium (hypernatremia) often causes confusion and is treated by rehydration. Low potassium (hypokalemia) commonly involves muscle weakness and cardiac arrhythmias, treated by oral or IV potassium replacement. High potassium (hyperkalemia) can alter the electrocardiogram and potentially cause fatal arrhythmias. Electrolyte levels must be closely monitored during treatment.
Sodium correction
Sodium is the most abundant cation in extracellular fluid and accounts for 90% of plasma osmotic activity. Normal sodium levels are 130-145 mEq/L. Hyponatremia is defined as sodium <130 mEq/L and is classified as mild, moderate or severe based on sodium levels. Hypernatremia is defined as sodium >145 mEq/L. Causes, clinical features, and management of hypo- and hypernatremia are discussed. Slow correction of sodium levels is important to avoid complications.
Approach to hyponatremia
Hyponatremia is the most common electrolyte abnormality seen in hospitalized patients. It is caused by an imbalance of water in the body, resulting in a dilution of sodium concentration. The document discusses the various types of hyponatremia (hypovolemic, euvolemic, hypervolemic) based on extracellular fluid volume status and their underlying causes such as SIADH, heart failure, liver cirrhosis. It also covers the diagnostic evaluation, management principles, and treatment approaches for acute symptomatic and chronic hyponatremia which involves slow correction of sodium levels to avoid osmotic demyelination syndrome.
Hyopna 9090909
This document provides an overview of hyponatremia, including:
1) Definitions, epidemiology, physiology, pathophysiology, types, clinical manifestations, diagnosis, and treatment of hyponatremia are discussed.
2) Hyponatremia is defined as a serum sodium concentration less than 135 mEq/L and is the most common electrolyte disorder. It can develop acutely or chronically.
3) Treatment involves addressing volume status, rate of sodium correction based on chronicity, and use of saline or water restriction depending on the type of hyponatremia. Complex formulas are provided to calculate sodium changes from intravenous fluids.
Hyopna 9090909
1. Hyponatremia is the most common electrolyte disorder, defined as a serum sodium concentration less than 135 mEq/L. It represents an excess of water relative to sodium.
2. The pathophysiology involves impaired free water excretion leading to a decrease in serum osmolality and brain cell swelling. Types include hypovolemic, euvolemic, hypervolemic, and redistributive hyponatremia.
3. Clinical manifestations range from asymptomatic to neurologic symptoms. Diagnosis involves assessing volume status, plasma and urine osmolality, and urine sodium. Treatment depends on symptoms, acuity, and volume status with goals of correcting sodium at appropriate rates.
Hyopna 9090909
This document provides an overview of hyponatremia, including its definition, epidemiology, physiology, pathophysiology, types, clinical manifestations, diagnosis, and treatment. Some key points include:
- Hyponatremia is defined as a serum sodium concentration of less than 135 mEq/L. It represents an excess of water relative to sodium.
- It is a very common electrolyte disorder, occurring in approximately 1-2.5% of hospitalized patients and up to 30% of ICU patients. Mortality is over 50% if sodium drops below 105 mEq/L.
- The kidney regulates sodium levels through ADH secretion, the renin-angiotensin-
Hyopna 9090909
This document provides an overview of hyponatremia, including its definition, epidemiology, physiology, pathophysiology, types, clinical manifestations, diagnosis, and treatment. Some key points include:
- Hyponatremia is defined as a serum sodium concentration of less than 135 mEq/L. It represents an excess of water relative to sodium.
- It is a very common electrolyte disorder, occurring in approximately 1-2.5% of hospitalized patients and up to 30% of ICU patients. Mortality is over 50% if sodium drops below 105 mEq/L.
- The physiology of sodium regulation involves thirst, ADH secretion, and renal sodium handling in response to
SODIUM HOMEOSTASIS
Sodium homeostasis and the regulation of serum sodium concentration is essential for normal physiological functioning. Hyponatremia occurs when there is a relative excess of water compared to sodium, decreasing the plasma sodium concentration below 135 mmol/L. It can be hypo-osmolar, euvolemic, or hypervolemic depending on water and sodium levels. Treatment involves correcting the underlying cause, restricting water intake, and sometimes using hypertonic saline or vaptans. Rapid correction of sodium levels can have neurological consequences, so changes should be gradual. Hypernatremia is less common but also dangerous, defined as a sodium level over 145 mmol/L.
Sodium imbalance
This document discusses sodium imbalance and hyponatremia. It provides details on:
- Normal sodium regulation and the causes of hyponatremia being related to water excess relative to sodium.
- The approach to evaluating hyponatremia by measuring osmolality, estimating volume status, and getting urinary sodium and osmolality levels.
- Specific causes of hyponatremia like SIADH, cerebral salt wasting, and mineralocorticoid deficiency.
- The treatment of hyponatremia depending on if it is acute or chronic and correcting it slowly to avoid osmotic demyelination syndrome.
Hyponatremia
The document discusses hyponatremia, defining it as a low serum sodium concentration and describing the physiology and pathophysiology of sodium regulation in the body. It examines the epidemiology, classification, clinical manifestations, diagnosis, and treatment of hyponatremia, providing details on evaluating volume status, calculating sodium deficits, and correcting sodium levels based on chronicity and symptoms.
Hyponatremia by sadek al rokh
This document discusses guidelines for the diagnosis and management of hyponatremia according to NICE. It defines hyponatremia as a sodium level below 135 mEq/L and describes its causes including hypovolemic, hypervolemic, and euvolemic types. It outlines approaches to evaluating volume status and correcting sodium levels, noting the importance of avoiding rapid overcorrection to prevent osmotic demyelination syndrome. Treatment involves fluid restriction, hypertonic saline in severe cases, and addressing underlying causes such as SIADH. Special considerations are given for cirrhosis, adrenal insufficiency, and drug-induced hyponatremia.
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HYPONATREMIA.pptx
- 1. HYPONATREMIA
- 2. Definition Serum concentration level less than 135meq/l Hyponatremia is the most common electrolyte abnormality in hospitalised patient It directly correlates with patients morbidity and mortality of hospitalised patient
- 3. ● Clinical features Depends on severity of hyponatremia and rapidity of progression of hyponatremia ● Nausea ● Vomiting ● Malaise ● Lethargy ● Confusion ● Headache ● Delirium ● Disorientation
- 4. Clinical features ● Respiratory failure (normocapnic/hypercapnic) Normocapnic respiratory failure because of non cardiogenic.Its neurogenic pulmonary edema normal pcwp ● Seizure ● Coma(<113) ● Death(<100)
- 6. Hypovolemic Hyponatremia Hypovolemic hyponatremia-->increased Circulating AVP-- >HTN(mild)V1A+increased reabsorption of water via V2 1.GIT-loss of Na-Cl U Na<20mM On IV NS increase of Na 2. Renal-Volume depletion and increases of AVP U Na>20mM Hypoaldosteronism Salt losing nephropathy(Reflex nephropathy) Increased excretion of osmotically active substances
- 7. Hypervolemic hyponatremia Increase of Na-Cl <<< increase of TBW U Na low Eg CCF, Cirrhosis
- 8. Euvolemic Hyponatremia Hypothyroidism (moderate to severe) Glucocorticoid deficiency (Glucocorticoid → × secretion of ADH hence hydrocortisone replacement rapidly corrects hyponatremia) SIADH Inappropriate secretion Failure to suppress ADH secretion with low osmolality Reset osmostat Impaired (gain in function of receptor)
- 9. Euvolemic Hyponatremia Low salt intake-->beer Hyponatremia Endurance exercise-loss of fluid Ave salt via sweat and Intake of low osmolar fluid intake
- 10. Plasma osmolality Plasma osmolality=2Na+BUN/2.8+Glucose/18 ● HYPONATREMIA with normal high osmolality should exclude psuedohyponatremia ● Psuedohyponatremia not causes Brain oedema ● HYPONATREMIA with oedema causes are nephrotic syndrome, liver cirrhosis, cardiac failure ● Associated with hypokalemia with metabolic alkalosis- vomiting, diuretic (thiazide)
- 11. Approach >Isotonic hyponatremia- measured osmolality Normal but calculated osmolality will be lower Eg-Multiple myeloma,hypergammaglobulinemia >Hypertonic hyponatremia-measured osmolality higher but calculated calculated osmolality lower, Eg-hyperglycemia, mannitol
- 12. Steps in evaluation Measurement of plasma osmolality Low-True hyponatremia High/Normal-psuedohyponatremia Measure urine osmolality <100mosm/kg or sp gravity<1.003-primary polydipsia >100mosm/kg other causes in which water excretion impaired Urine Na <15mEq/L-diarrhoea, vomiting >15mEq/L-SIADH or salt wasting syndrome
- 13. Treatment In acute condition rapid correction can be given In chronic condition rapid correction should not be given as cortical pontine myelinolysis can occur
- 14. General guidelines ● Target correction-10-12meq/l on day 1 and<18meq/l in best 2 days ● >25meq/l48hrs:-central pontine myelinolysis ● R/f central pontine myelinolysis ● Hypoxemia ● Hypokalemia ● Malnutrition ● Alcoholism ● Severe malnutrition
- 15. Treatment of hyponatremia Treatment principles 1.Treatment should be individualised based on etiology, severity, clinical symptom 2.NS given to compenstae postsuppy overdiuresis
- 16. Hyponatremia Treatment 1.Hypovolumia-Salt water supplementation 2.Oedema-- salt and fluid restriction,loop diuretics 3.Normovolumia-fluid restriction
- 17. Treatment ->Hypovolemic patients should be given isotonic fluid which increases sodium level -Patient with cerebral salt wasting syndrome-hypertonic saline/fludrocort Psuedohyponatremia -requires no sodium correction. ->acute hyponatremia (eg, exercise-associated hyponatremia) with severe neurologic manifestations can be reversed rapidly with 100 mL of 3% hypertonic saline infused over 10 minutes ->For severe cases initial 4-6meq correction to be given(can be repeated twice
- 18. Treatment ->initial step in hyponatremia management since excessive free water intake will exacerbate hyponatre- mia. ->Free water clearance by the kidneys must exceed free water intake for the serum sodium concentration to rise. ->Free water intake should generally be less than 1–1.5 L/day ->patients with minimal free water clearance, and hypertonic saline may be necessary in patients with nega- tive free water clearance.
- 19. Treatment For patient with rapid correction in chronic hyponatremia 5%dextrose+ddavp given to be given HYPONATREMIA correction formula Sodium deficit = Total body water (TBW) × (Desired serum Na – Actual serum Na)
- 20. Hypovolemia-Isotonic fluid (to prevent Hypovolemia-Isotonic induced ash secretion) Cerebral salt wasting syndrome-hypertonic saline to prevent circulatory collapse
- 21. Specific treatment ● Treat underlying causes-adrenal insufficiency, hypothyroidism, nephrotic syndrome ● Removal of offending drugs- Tthiazides,chlorptomide,cyclophosphamide
- 22. Treatment Delivery rate ->3% hypertonic saline has a sodium concentration of 513 mEq/1000 mL. The delivery rate for hypertonic saline can be calculated as: Delivery rate = Sodium deficit/(513 mEq/1000 mL)/ 24 hours
- 23. Calculate Na deficit Na deficit=TBW(desired Na-present Na) Tbw=0.6×Body weight (0.5for female)
- 24. References ● CMDT 2018 ● HARRISON PRINCIPLES OF INTERNAL MEDICINE ● CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 71 • NUMBER 8 AUGUST 2004
- 25. THANK YOU