Interesting case of hyponatraemia (Scop)
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This patient presented with a low Glasgow Coma Scale and stable vitals following a motor vehicle accident. Laboratory tests revealed hyponatremia with a sodium level of 106 mmol/L, normal anion gap, and normal osmolality. Further examination found a distended abdomen and over 1000 mL of urine in the bladder. The urine sodium was elevated at 85 mmol/L, indicating the hyponatremia was likely caused by syndrome of inappropriate antidiuretic hormone secretion (SIADH). The patient was treated with hypertonic saline to slowly correct the sodium levels and prevent complications.
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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.
Hyponatremia
Hyponatremia is a common electrolyte abnormality seen in clinical practice. It is defined as a serum sodium level below 135 mmol/L. The main types are isotonic, hypertonic, and hypotonic hyponatremia. Causes include diuretic use, liver cirrhosis, heart failure, and SIADH. Diagnosis involves lab tests and imaging. Management depends on severity and rate of onset, with slow correction for chronic cases to avoid osmotic demyelination syndrome. Fluid restriction and vasopressin antagonists are often used to treat euvolemic hyponatremia.
New microsoft office power point presentation
This document describes the case of a 68-year-old woman presenting with chest pain and shortness of breath who was found to have hyponatremia. On examination, she had mild edema but normal vital signs. Tests found euvolemic hyponatremia with normal kidney function. She developed altered mental status after thrombolytic therapy for her heart attack. Hyponatremia was classified as SIAD based on lab results. Management focused on slow correction and monitoring for complications.
hyponatremia -my prensentation
Hyponatremia is defined as a serum sodium concentration below 135 meq/L. The serum sodium concentration is determined by the balance of sodium and other electrolytes in the total body water. Hyponatremia can be classified as hypovolaemic, euvolemic, or hypervolaemic based on volume status. Common causes include syndrome of inappropriate antidiuretic hormone secretion, heart failure, liver cirrhosis, and use of thiazide diuretics. Symptoms range from nausea and headache with acute hyponatremia to more severe symptoms like seizures and coma. Treatment involves correcting underlying causes and raising serum sodium levels slowly to avoid osmotic demyelination
Approach to hyponatremia
This document discusses the approach to a patient presenting with hyponatremia. It begins by outlining the clinical scenario of a 74-year-old man with recent gastroenteritis, fatigue, headache and a sodium level of 118. It then provides definitions and discusses evaluating hyponatremia by assessing serum osmolality, urine osmolality and volume status. Based on these factors, the patient's hyponatremia is likely due to volume depletion from gastroenteritis. The document concludes by stating the patient should be treated slowly with isotonic saline given mild symptoms, but more rapid correction with hypertonic saline would be needed if seizures were present.
Hyponatremia (1)
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.
Hyponatremia 2015 final
This document discusses disturbances in sodium and water balance, including hyponatremia and hypernatremia. It notes that hyponatremia is usually caused by excess water intake that cannot be excreted fully, while hypernatremia is caused by too little water intake. Symptoms depend on severity and include nausea, headaches, seizures or coma. Treatment of hyponatremia involves careful correction of sodium levels to avoid complications. Diagnosis requires assessing volume status and osmolality to determine the underlying cause.
Hyponatremia management pearls 1
This document discusses the diagnosis and treatment of hyponatremia. It defines acute and chronic hyponatremia and outlines their differing risks. For severe symptoms, it recommends rapidly increasing serum sodium with 3% saline to prevent brain herniation. For moderate symptoms, the priority is preventing further sodium decreases rather than increases. Asymptomatic hyponatremia should be treated by optimizing volume status and restricting fluid intake. The risks of unpredictable rapid sodium correction are also covered.
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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.
Hyponatremia
Hyponatremia is a common electrolyte abnormality seen in clinical practice. It is defined as a serum sodium level below 135 mmol/L. The main types are isotonic, hypertonic, and hypotonic hyponatremia. Causes include diuretic use, liver cirrhosis, heart failure, and SIADH. Diagnosis involves lab tests and imaging. Management depends on severity and rate of onset, with slow correction for chronic cases to avoid osmotic demyelination syndrome. Fluid restriction and vasopressin antagonists are often used to treat euvolemic hyponatremia.
New microsoft office power point presentation
This document describes the case of a 68-year-old woman presenting with chest pain and shortness of breath who was found to have hyponatremia. On examination, she had mild edema but normal vital signs. Tests found euvolemic hyponatremia with normal kidney function. She developed altered mental status after thrombolytic therapy for her heart attack. Hyponatremia was classified as SIAD based on lab results. Management focused on slow correction and monitoring for complications.
hyponatremia -my prensentation
Hyponatremia is defined as a serum sodium concentration below 135 meq/L. The serum sodium concentration is determined by the balance of sodium and other electrolytes in the total body water. Hyponatremia can be classified as hypovolaemic, euvolemic, or hypervolaemic based on volume status. Common causes include syndrome of inappropriate antidiuretic hormone secretion, heart failure, liver cirrhosis, and use of thiazide diuretics. Symptoms range from nausea and headache with acute hyponatremia to more severe symptoms like seizures and coma. Treatment involves correcting underlying causes and raising serum sodium levels slowly to avoid osmotic demyelination
Approach to hyponatremia
This document discusses the approach to a patient presenting with hyponatremia. It begins by outlining the clinical scenario of a 74-year-old man with recent gastroenteritis, fatigue, headache and a sodium level of 118. It then provides definitions and discusses evaluating hyponatremia by assessing serum osmolality, urine osmolality and volume status. Based on these factors, the patient's hyponatremia is likely due to volume depletion from gastroenteritis. The document concludes by stating the patient should be treated slowly with isotonic saline given mild symptoms, but more rapid correction with hypertonic saline would be needed if seizures were present.
Hyponatremia (1)
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.
Hyponatremia 2015 final
This document discusses disturbances in sodium and water balance, including hyponatremia and hypernatremia. It notes that hyponatremia is usually caused by excess water intake that cannot be excreted fully, while hypernatremia is caused by too little water intake. Symptoms depend on severity and include nausea, headaches, seizures or coma. Treatment of hyponatremia involves careful correction of sodium levels to avoid complications. Diagnosis requires assessing volume status and osmolality to determine the underlying cause.
Hyponatremia management pearls 1
This document discusses the diagnosis and treatment of hyponatremia. It defines acute and chronic hyponatremia and outlines their differing risks. For severe symptoms, it recommends rapidly increasing serum sodium with 3% saline to prevent brain herniation. For moderate symptoms, the priority is preventing further sodium decreases rather than increases. Asymptomatic hyponatremia should be treated by optimizing volume status and restricting fluid intake. The risks of unpredictable rapid sodium correction are also covered.
Hyponatremia
This document discusses hyponatremia, defining it as a serum sodium level below 135 mEq/L. It classifies hyponatremia based on severity and chronicity. The physiology of water balance and factors regulating vasopressin are described. Causes of hyponatremia include hypovolaemia, euvoleamia, and hypervoleamia. SIADH criteria and causes are provided. A case report of refractory hyponatremia due to SIADH from cortical vein thrombosis and antithrombin III deficiency is summarized.
Hyponatremia
Hyponatremia is caused by an imbalance between water and sodium in the body that results in low sodium levels in the blood. The document discusses the physiology and classifications of hyponatremia. It provides several case scenarios and reviews the clinical manifestations, diagnosis, and management based on the severity, time of onset, volume status, and underlying cause. Management involves correcting fluid and sodium levels and treating the underlying condition, with close monitoring to prevent rapid sodium correction which can lead to neurological complications.
Hyponatremia
Hyponatremia is the most common electrolyte disorder characterized by a serum sodium level below 135 mEq/L. It is often seen in hospitalized patients, the elderly, and females. Common causes include diuretic use, diarrhea, heart failure, and renal disease. Symptoms are primarily neurological due to cerebral edema and range from headache to seizures. Treatment involves restricting water intake, replacing sodium deficits, and treating the underlying cause while avoiding too rapid of a sodium correction to prevent osmotic demyelination syndrome.
Hyponatremia gulidelines
This document provides guidelines for the diagnosis and management of hyponatremia. It defines hyponatremia as a serum sodium concentration of less than 135 mEq/L. It notes that hyponatremia is commonly seen in hospitalized patients and can cause neurological symptoms if left untreated. The guidelines recommend a systematic approach to hyponatremia involving assessing volume status, urine and serum osmolality to determine the cause (hypovolemic, euvolemic, or hypervolemic), and correcting any underlying conditions and sodium levels slowly to avoid complications. Newer vasopressin receptor antagonists called vaptans can be useful for treating euvolemic or hypervolemic hy
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.
hyponatremia hypernatremia
1. Hyponatremia is defined as a plasma sodium concentration less than 135 mEq/L. It can be caused by an increase in circulating antidiuretic hormone (ADH) and water intake.
2. Hyponatremia is classified based on volume status and can be hypovolemic, euvolemic, or hypervolemic. Common causes include diuretic use, vomiting, cirrhosis, and heart failure.
3. SIADH is a frequent cause of euvolemic hyponatremia and results in inappropriate water retention due to abnormal ADH secretion or action. Pseudo hyponatremia can occur due to errors in sodium measurement
Hyponatremia
This document discusses hyponatremia, which is caused by an excess of water in the body relative to sodium. It describes how sodium levels indicate tonicity rather than just osmolality. Pseudohyponatremia can occur with hyperglycemia. Treatment depends on whether the patient is hypovolemic, euvolemic, or hypervolemic. Symptomatic hyponatremia should be treated cautiously with hypertonic saline to avoid complications like central pontine myelinolysis.
Hyponatremia.pptx avinash gupta
This document discusses hyponatremia, defined as a plasma sodium concentration less than 135mM. Hyponatremia is common, occurring in up to 22% of hospitalized patients and 15% of general admissions. It can be associated with poor outcomes if left untreated. The mechanism is usually an increase in arginine vasopressin leading to water retention. Causes include SIADH, heart failure, liver cirrhosis, and use of certain drugs. Treatment involves restricting water intake, replacing sodium deficits, and treating the underlying cause. Rapid correction of sodium levels should be avoided to prevent neurological complications.
3281 hyponatremia practicetool
This document provides guidance on diagnosing and managing hyponatremia. It discusses severe symptomatic hyponatremia which requires prompt correction by increasing sodium levels by 4-6 mEq/L with IV saline boluses. Major considerations for management include treating underlying conditions and avoiding overcorrection for chronic hyponatremia. It also outlines evaluating volume status, urine sodium and osmolality to determine the cause and appropriate treatment of hyponatremia, whether it be fluid restriction, saline, or in severe cases ICU admission or dialysis.
Hyponatremia- Fishing in troubled waters.
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
It is difficult to clinically distinguish SIADH from volume depletion in hyponatremic patients without edema, with correct prediction occurring in only around 40% of cases. The gold standard for diagnosis is the sodium response to fluid challenge. A urine sodium less than 30 mmol/L favors SIADH, but this can miss salt depletion in elderly patients. A fractional excretion of sodium less than 0.5% identifies patients with salt depletion but misclassifies around half of SIADH cases. Combined fractional excretion of sodium less than 0.5% and urea less than 55% may best differentiate SIADH from salt depletion.
Hyponatremia in children
Hyponatremia is very common in critically ill children, occurring in 20-45% of PICU admissions. It is usually caused by impaired free water excretion leading to dilutional hyponatremia from water retention and intake of hypotonic fluids. Other potential causes include inappropriate vasopressin secretion, redistribution of sodium and water in conditions like sepsis, use of hypotonic intravenous fluids, and underlying illnesses or medications. The diagnosis involves measuring plasma and urine osmolality and sodium levels, and clinically assessing volume status, to determine if the hyponatremia is hypovolemic, hypervolemic, or euvolemic in nature.
Hyponatremia
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.
Hyponatremia in ICU patients
- Hyponatremia in ICU patients is commonly caused by inappropriate secretion of antidiuretic hormone leading to retention of free water.
- The brain adapts slowly to changes in serum sodium levels over 48 hours; rapid corrections can cause serious complications like osmotic demyelination syndrome.
- Treatment goals for hyponatremia are to correct the sodium level slowly at a rate of no more than 6 mEq/L per day to prevent neurological complications while relieving symptoms.
Hyponatremia by Dr. Basil Tumaini
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The document categorizes hyponatremia based on plasma osmolality as hypertonic, isotonic or hypotonic. It discusses the various types in more detail including hypovolemic, euvolemic and hypervolemic causes. Treatment depends on the specific cause but may involve sodium supplementation, fluid restriction or medications. Chronic hyponatremia requires especially slow correction to avoid
Hyponatremia ppt .final
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.
Hyponatraemia
A 65-year-old woman presented with increasing confusion and lethargy over the past week. Laboratory tests revealed severe hyponatremia with a serum sodium of 108 mmol/L, low osmolality, and urine osmolality of 400 mOsm/kg. She has no other illnesses that could explain her symptoms. The most likely diagnosis is syndrome of inappropriate antidiuretic hormone secretion (SIADH) given her clinical presentation and lab results.
Hyponatremia
This document provides an overview of hyponatremia for ER and ICU physicians. It defines hyponatremia and discusses assessing a patient's volume status to determine the underlying cause. Causes include SIADH, psychogenic polydipsia, and medications. The summary outlines evaluating symptoms, identifying the cause, calculating sodium deficit, and correcting hyponatremia slowly at 0.5 mEq/hr or up to 1-2 mEq/hr if acute, not exceeding 12 mEq/L/day. Hypertonic saline or 0.9% saline may be used to correct deficits based on total body water and target sodium level.
Hyponatreamia
This document discusses hyponatremia, including its causes, assessment, and management. It defines acute and chronic hyponatremia and their associated symptoms. It also describes pseudohyponatremia and discusses differentiating true hyponatremia from pseudohyponatremia. The document outlines criteria for diagnosing SIADH and guidelines for managing hyponatremia based on its severity and whether it is acute or chronic.
Water, Sodium Handling and Hyponatraemia
This presentation was done in October 2011 for an SpR seminar. It's exhaustive, but I hope you will learn somethng helpful!
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Hyponatremia
This document discusses hyponatremia, defining it as a serum sodium level below 135 mEq/L. It classifies hyponatremia based on severity and chronicity. The physiology of water balance and factors regulating vasopressin are described. Causes of hyponatremia include hypovolaemia, euvoleamia, and hypervoleamia. SIADH criteria and causes are provided. A case report of refractory hyponatremia due to SIADH from cortical vein thrombosis and antithrombin III deficiency is summarized.
Hyponatremia
Hyponatremia is caused by an imbalance between water and sodium in the body that results in low sodium levels in the blood. The document discusses the physiology and classifications of hyponatremia. It provides several case scenarios and reviews the clinical manifestations, diagnosis, and management based on the severity, time of onset, volume status, and underlying cause. Management involves correcting fluid and sodium levels and treating the underlying condition, with close monitoring to prevent rapid sodium correction which can lead to neurological complications.
Hyponatremia
Hyponatremia is the most common electrolyte disorder characterized by a serum sodium level below 135 mEq/L. It is often seen in hospitalized patients, the elderly, and females. Common causes include diuretic use, diarrhea, heart failure, and renal disease. Symptoms are primarily neurological due to cerebral edema and range from headache to seizures. Treatment involves restricting water intake, replacing sodium deficits, and treating the underlying cause while avoiding too rapid of a sodium correction to prevent osmotic demyelination syndrome.
Hyponatremia gulidelines
This document provides guidelines for the diagnosis and management of hyponatremia. It defines hyponatremia as a serum sodium concentration of less than 135 mEq/L. It notes that hyponatremia is commonly seen in hospitalized patients and can cause neurological symptoms if left untreated. The guidelines recommend a systematic approach to hyponatremia involving assessing volume status, urine and serum osmolality to determine the cause (hypovolemic, euvolemic, or hypervolemic), and correcting any underlying conditions and sodium levels slowly to avoid complications. Newer vasopressin receptor antagonists called vaptans can be useful for treating euvolemic or hypervolemic hy
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.
hyponatremia hypernatremia
1. Hyponatremia is defined as a plasma sodium concentration less than 135 mEq/L. It can be caused by an increase in circulating antidiuretic hormone (ADH) and water intake.
2. Hyponatremia is classified based on volume status and can be hypovolemic, euvolemic, or hypervolemic. Common causes include diuretic use, vomiting, cirrhosis, and heart failure.
3. SIADH is a frequent cause of euvolemic hyponatremia and results in inappropriate water retention due to abnormal ADH secretion or action. Pseudo hyponatremia can occur due to errors in sodium measurement
Hyponatremia
This document discusses hyponatremia, which is caused by an excess of water in the body relative to sodium. It describes how sodium levels indicate tonicity rather than just osmolality. Pseudohyponatremia can occur with hyperglycemia. Treatment depends on whether the patient is hypovolemic, euvolemic, or hypervolemic. Symptomatic hyponatremia should be treated cautiously with hypertonic saline to avoid complications like central pontine myelinolysis.
Hyponatremia.pptx avinash gupta
This document discusses hyponatremia, defined as a plasma sodium concentration less than 135mM. Hyponatremia is common, occurring in up to 22% of hospitalized patients and 15% of general admissions. It can be associated with poor outcomes if left untreated. The mechanism is usually an increase in arginine vasopressin leading to water retention. Causes include SIADH, heart failure, liver cirrhosis, and use of certain drugs. Treatment involves restricting water intake, replacing sodium deficits, and treating the underlying cause. Rapid correction of sodium levels should be avoided to prevent neurological complications.
3281 hyponatremia practicetool
This document provides guidance on diagnosing and managing hyponatremia. It discusses severe symptomatic hyponatremia which requires prompt correction by increasing sodium levels by 4-6 mEq/L with IV saline boluses. Major considerations for management include treating underlying conditions and avoiding overcorrection for chronic hyponatremia. It also outlines evaluating volume status, urine sodium and osmolality to determine the cause and appropriate treatment of hyponatremia, whether it be fluid restriction, saline, or in severe cases ICU admission or dialysis.
Hyponatremia- Fishing in troubled waters.
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
It is difficult to clinically distinguish SIADH from volume depletion in hyponatremic patients without edema, with correct prediction occurring in only around 40% of cases. The gold standard for diagnosis is the sodium response to fluid challenge. A urine sodium less than 30 mmol/L favors SIADH, but this can miss salt depletion in elderly patients. A fractional excretion of sodium less than 0.5% identifies patients with salt depletion but misclassifies around half of SIADH cases. Combined fractional excretion of sodium less than 0.5% and urea less than 55% may best differentiate SIADH from salt depletion.
Hyponatremia in children
Hyponatremia is very common in critically ill children, occurring in 20-45% of PICU admissions. It is usually caused by impaired free water excretion leading to dilutional hyponatremia from water retention and intake of hypotonic fluids. Other potential causes include inappropriate vasopressin secretion, redistribution of sodium and water in conditions like sepsis, use of hypotonic intravenous fluids, and underlying illnesses or medications. The diagnosis involves measuring plasma and urine osmolality and sodium levels, and clinically assessing volume status, to determine if the hyponatremia is hypovolemic, hypervolemic, or euvolemic in nature.
Hyponatremia
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.
Hyponatremia in ICU patients
- Hyponatremia in ICU patients is commonly caused by inappropriate secretion of antidiuretic hormone leading to retention of free water.
- The brain adapts slowly to changes in serum sodium levels over 48 hours; rapid corrections can cause serious complications like osmotic demyelination syndrome.
- Treatment goals for hyponatremia are to correct the sodium level slowly at a rate of no more than 6 mEq/L per day to prevent neurological complications while relieving symptoms.
Hyponatremia by Dr. Basil Tumaini
Hyponatremia by Dr. Basil Tumaini. Presented at Association of Physicians of Tanzania Conference in 2018.
A New Perspective on Hyponatremia
This document discusses hyponatremia (low sodium levels in blood). It begins by defining hyponatremia as a sodium level below 135 meq/L. It then describes the causes and symptoms of hyponatremia, which can include headache, vomiting, seizures and coma depending on severity.
The document categorizes hyponatremia based on plasma osmolality as hypertonic, isotonic or hypotonic. It discusses the various types in more detail including hypovolemic, euvolemic and hypervolemic causes. Treatment depends on the specific cause but may involve sodium supplementation, fluid restriction or medications. Chronic hyponatremia requires especially slow correction to avoid
Hyponatremia ppt .final
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.
Hyponatraemia
A 65-year-old woman presented with increasing confusion and lethargy over the past week. Laboratory tests revealed severe hyponatremia with a serum sodium of 108 mmol/L, low osmolality, and urine osmolality of 400 mOsm/kg. She has no other illnesses that could explain her symptoms. The most likely diagnosis is syndrome of inappropriate antidiuretic hormone secretion (SIADH) given her clinical presentation and lab results.
Hyponatremia
This document provides an overview of hyponatremia for ER and ICU physicians. It defines hyponatremia and discusses assessing a patient's volume status to determine the underlying cause. Causes include SIADH, psychogenic polydipsia, and medications. The summary outlines evaluating symptoms, identifying the cause, calculating sodium deficit, and correcting hyponatremia slowly at 0.5 mEq/hr or up to 1-2 mEq/hr if acute, not exceeding 12 mEq/L/day. Hypertonic saline or 0.9% saline may be used to correct deficits based on total body water and target sodium level.
Hyponatreamia
This document discusses hyponatremia, including its causes, assessment, and management. It defines acute and chronic hyponatremia and their associated symptoms. It also describes pseudohyponatremia and discusses differentiating true hyponatremia from pseudohyponatremia. The document outlines criteria for diagnosing SIADH and guidelines for managing hyponatremia based on its severity and whether it is acute or chronic.
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Hyponatremia
This document discusses hyponatremia, which is caused by an excess of water in the body relative to sodium. It describes how sodium levels indicate tonicity rather than just osmolality. Pseudohyponatremia can occur with hyperglycemia. Treatment depends on whether the patient is hypovolemic, euvolemic, or hypervolemic. Symptomatic hyponatremia should be treated cautiously with hypertonic saline to avoid complications like central pontine myelinolysis.
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4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
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Interesting case of hyponatraemia (Scop)
- 2. CAT 1 • Patient low GCS • Vitals stable • Hx of MVA on weekend • 89 female
- 3. T1 • GCS 1 1 3 • Vitals stable 140/70, 99%RA • Breathing spontaneously • Pupils 4 and reactive • Systemic exam: large distended abdomen
- 4. Differential • Trauma • Toxic • Metabolic – Na – Glucose • Infective • CNS – Tumour SOL
- 5. Here comes the VBG • VBG – Na 106 – Glu 6.8 – PCO2 37 – HCO3 28 – PH 7.49 – Ur 6.0 • REVISIT THE HISTORY
- 6. What is the cause? • Hyponatraemia – Hypovolaemia – Euvolaemia – Hypervolaemia
- 7. HypoVol HypoNA • Renal losses (Na>20) – Diuretics – Addison’s disease – Osmotic diuresis – Ketonuria – Salt loosing nephropathies – RTA
- 8. HypoVol HypoNA • Extrarenal renal losses (<20) – Sweating – Vomiting – Diarrhoea – Third space loss
- 9. YOU FORGOT HER ABDOMEN • Distended • Bladder scan>1000ml • 1.5 urine drained following catheter
- 10. • Urine spot sodium – >20mmol (R) vs. <20 (ER) • 85mmol/L – Urine osmolality • 399mmol/L • Sodium osmolality – 2(NA) + glucose + Urea= 224.8mmol/L (calculated) • 204mmol/L (measured)
- 11. Euvolaemic HypoNA • SIADH – Urine>plasma osmolality – Urine NA >20 • Water intoxication • Psychogenic polydipsia • Amphetamines • Beer potomania – U<P osmolality NA<20
- 12. SIADH • Euvolaemic hypoNA <135mmol/l • Plasma osmolality <280 • Urine osmolality >100 • Urine Na>20mmol • Absence of ECF depletion • Normal thyroid and adrenal function • Normal cardiac, hepatic and renal function • No diuretic usage
- 13. SIADH • Nervous system • Respiratory system • Neoplasia • Drugs – Emedicine has an extensive list
- 14. CLINICAL • >125mmol/l Asymptomatic • 115-125 Lethargy, confusion, anorexia, N+V • <115 Muscle cramps, weakness, convulsion and coma
- 15. Preventing Complications • Cerebral oedema • ECG changes – Non ischaemic ST elevation • Pontine demyelinosis – No clear evidence that is associated with rapids correction – Develops 3-5 days after treatment
- 16. • Patients with hyponataremia and severe symptoms should receive hypertonic saline but only enough to raise the serum sodium level by 4-6 mmol/L and to arrest seizure activity. • Further correction should proceed at an overall rate that is no greater than 10-12 mmol/L in the first 24 hours and no greater than 18 mmol/L in the first 48 hours
- 17. What to do • Sodium replacement – Super salt • 20% solution 10mls=34mmol – 3% solution • 513mmol/L – 0.9% solution • 154mmol/L
- 18. 3% Solution • 513mmol/l (IDEAL-but don’t have) • 30mls of a 20% saline solution (supersalt) – 6g of sodium (10mls=2g) • Add to 250mls of 0.9% NACL – 2.25g of sodium (0.9g per 100ml) • 8.85g=280mls of saline • 31.5g=1000ml=3.1%
- 19. • 0.9% NACL of 100ml solution= 0.9g of NACL • 0.9% NACL of 1000ml solution= 9g of NACL • 3% NACL of 1000ml solution= 30g of NACL • There are 154mmol and 9 grams in 1L of 0.9% NACL. • There are thus 17mmol and 1 gram in 1L of 0.9% NACL • Therefore 30 grams requires 513mmol in 1L of 3% NACL (30 X 17)
- 20. • 3ml/kg of a 3% solution will raise sodium by 3 mmol (pt weight 50kgs) • 150ml of a 3% will raise sodium by 3mmol • NOT MORE THAN 10 mmol/day • 450ml/24hrs • 18.75ml/hour
Editor's Notes
- Psychoactive-MAOI, SSRI, TCA, NSAIDS, Chlorpromasine, chemotherapeutiv cause SIADH
- Altered mental state, dysphasia, spastic quadrapesis
- 1% saline in 100ml=1g of saline500ml saline contains 4.5g