Discover and read the best of Twitter Threads about #hyponatremia

Most recents (6)

Record #heat. Tough weekend in the #PNW. Seattle=City with #1 lowest AC. For sure - heat-related illness and deaths to happen. what to do? I share a #tweetorial about lessons learned from @FortBenning -when I was CMO of the hospital there.

Please retweet if useful. #medtwitter
In Georgia, our medical team had to tackle issues of heat illnesses - from heat exhaustion, heat strokes and exercise associated hyponatremia (#EAH) - and tragically the deaths too. We re-learned lessons lost from the past and learned new ones.
Lesson 1: Young, healthy, and fit people die in the heat.

There's no age discriminator for heat stroke. Heat that cannot be dissipated will kill anyone eventually. Heat comes from mainly two sources - the environment and the person; especially if exerting oneself.
Read 15 tweets
1/How can #POCUS #echofirst help in the evaluation of #hyponatremia?
#Nephrology consulted for low sodium. Pt received diuretic for shortness of breath (which was possibly due to hiatal hernia as shown on CXR).
2 physicians FELT patient was EUVOLEMIC
Small 🧵below 👇 #MedEd Image
2/Based on the above labs, it does look like euvolemic hyponatremia (Urine Na is high, Uosm >100 but not too high, BUN not high). BP was 150s systolic.
That's it? Give some salt tablets or UreNa etc.?
No; perform PHYSICAL EXAM (= #POCUS)
IVC was small - doesn't tell much 😬
3/ Next step? Look at the heart, assess stoke volume.
Recent echo LVEF>50%
LV contraction looks good visually
We measured LVOT VTI (couldn't measure LVOT diameter due to chest deformity precluding good PLAX view but its not a problem; VTI is generally enough)
#POCUS Image
Read 10 tweets
2/ The first question in hyponatremia is...


If you have a patient with cerebral edema from acute hyponatremia you need to 3% Saline first and ask questions later.
3/ If patients have hyponatremia and have severe symptoms it is 150 ml of 3% then recheck the sodium and give another 150 ml of 3% (I'm using the European guidelines)…
Read 20 tweets

It’s 1:34 p.m. and the ED pages you for hyponatremia. 📟

A 45 y/o M with no known medical history presents after a seizure with a sodium of 102 mEq/L.

#tweetorial #MedTwitter #Nephtwitter #hyponatremia @theskeletonkeygroup

What's your first move?

The initial evaluation of hyponatremia must “evaluate osmolality excluding hyperglycemia and other causes of non-hypotonic (SOsm >275) hyponatremia.” - per the European Guidelines (PMID: 24569125) 🇪🇺🇪🇺🇪🇺

We find a hyperosmolar hyponatremia:

What is the most likely cause of hyponatremia?
Read 22 tweets
1/ The answer to our last poll: cisplatin…

Below, a brief #tweetorial to walk through a simplified approach to #hyponatremia

Step 1: What type of hypoNa are we dealing with here?

Ex: Na 128 meq/L, glucose 500 mg/dL, BUN 20 mg/dL serum osm 292 mosm/kg

Remember the difference between tonicity (a measure of EFFECTIVE osmoles) & osmolality (measure of both EFFECTiVE & INEFFECTIVE osmoles)

Effective osmoles cannot cross between the ECF and ICF, thus draw water across the cell membrane.

If serum osm not low with hypoNa, we must look for the presence of ⬆️effective & ineffective osmoles (that ⬆️osmolality)

-If we find⬆️ effective osmoles ➡️ HYPERtonic hypoNa

-If we find ⬆️ INeffective osmoles ➡️ HYPOtonic hypoNa

-If neither ➡️ PseudohypoNa
Read 9 tweets
Time for another #tweetorial on fluid restriction in #hyponatremia from SIADH. Is there a way to predict which patients with SIADH will respond to fluid restriction?
1/It has been said that the first line therapy for SIADH is fluid restriction but 60-70% of patients with SIADH will not respond to fluid restriction alone and they require the addition of a drug (e.g., urea). How can we tell who will respond and who won’t?
2/We can predict responsiveness to fluid restriction by using the concept of electrolyte-free water clearance.
Read 15 tweets

Related hashtags

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!