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Robert Centor @medrants
, 8 tweets, 3 min read Read on Twitter
1/ #5goodminutes #KashlakChief has some tweetorial thoughts to add to:
Episode 2 – Hyponatremia – The Clinical Problem Solvers…
attn @DxRxEdu @CPSolvers @thecurbsiders Please ask for explanations if any of these points are confusing.
2/ Prior to giving saline to hyponatremic patients, please check urine osms. If they are very low (and the serum sodium is very low), you run the danger of overly fast correction and hence demyelination. If the urine osms suggest SIADH, then saline can lower Na significantly
3/ The best explanation for ineffective arterial volume comes from Schrier - here is my blog post from 10 years ago -
4/ I still like noting the edematous states as a category different from volume contraction. When confused between euvolemia and volume contraction in 2018 I like IVC ultrasound looking for IVC collapse
5/ In euvolemic hyponatremia, exclude 4 things - adrenal insufficiency, hypothyroidism, thiazides and CKD
6/ When you think patient has SIADH, ask yourself if the ADH is physiologic (volume, stress, pain, nausea, medication (opiates, SSRIs ...) or non-physiologic. This will change how you treat.
7/ Most dangerous hyponatremia patients have multiple causes. Examples: primary polydipsia + SSRI (I have seen this), thiazides + SSRI + tea and toast. Such patients are the most dangerous because they can correct too fast if you are not careful
8/ With sodium levels below 120 - follow correction very careful to avoid correcting quickly. For mild hyponatremia, remember that diagnosis is worthwhile to prevent the increased fall risk.
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