1/
When to use “corrected sodium” versus "measured sodium" in caring for a patient with hyperglycemia?
When to use “corrected sodium” versus "measured sodium" in caring for a patient with hyperglycemia?
2/
Should you use measured or corrected sodium when calculating the anion gap?
Should you use measured or corrected sodium when calculating the anion gap?
3/
Should you use measured or corrected sodium when treating a patient's sodium concentration w/ hyperglycemia?
Should you use measured or corrected sodium when treating a patient's sodium concentration w/ hyperglycemia?
4/
Why do we care about sodium? Because Na is a major contributor to osmolality. And osmolality is very important for cellular volume/function. Normally -> sOsm = 2 x Na.
Why do we care about sodium? Because Na is a major contributor to osmolality. And osmolality is very important for cellular volume/function. Normally -> sOsm = 2 x Na.
5/
Patients w/ hyperglycemic have relative insulin deficiency-> Glu cannot get into the cell and becomes an effective osmole-> Glu will draw water out of the cell
Patients w/ hyperglycemic have relative insulin deficiency-> Glu cannot get into the cell and becomes an effective osmole-> Glu will draw water out of the cell
6/
What does this do to serum Na? It dilutes it. And remember sodium is primarily an extracellular cation. How can we correct sodium for the dilutional effect caused by high Glu?
What does this do to serum Na? It dilutes it. And remember sodium is primarily an extracellular cation. How can we correct sodium for the dilutional effect caused by high Glu?
7/
For every 100 g/dL increase in glucose concentration, the corrected sodium would increase by 1.6 to 2.4. Most recommend using 2.4 when Glu > 400. bit.ly/3aN1ebD
For every 100 g/dL increase in glucose concentration, the corrected sodium would increase by 1.6 to 2.4. Most recommend using 2.4 when Glu > 400. bit.ly/3aN1ebD
8/
AG = Na – (HCO3 + Cl), and reflects the unmeasured anions. The dilution caused by Glu affects both cations and anions similarly, so use measured Na. If you use corrected, then you will overshoot AG.
AG = Na – (HCO3 + Cl), and reflects the unmeasured anions. The dilution caused by Glu affects both cations and anions similarly, so use measured Na. If you use corrected, then you will overshoot AG.
9/
Use corrected Na when treating sodium concentration in pt w/ elevated Glu. When you treat hyperglycemia -> water will travel back into the cell b/c removing tonic particle (Glu) -> sodium will rise quickly
Use corrected Na when treating sodium concentration in pt w/ elevated Glu. When you treat hyperglycemia -> water will travel back into the cell b/c removing tonic particle (Glu) -> sodium will rise quickly
10/
Have a LOVELY day and watch the video for a more in-depth discussion bit.ly/3b2uuv8
Have a LOVELY day and watch the video for a more in-depth discussion bit.ly/3b2uuv8
