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...

👏Is👏the👏patient👏seizing?👏

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) eje.bioscientifica.com/view/journals/…
Read 20 tweets
1a/14

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?
1b/14

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:
2a/14

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

nephsim.com/case-13-diagno…

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
2/

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.

nephsim.com/image-gallery/
3/

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

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