Hope you liked our latest post by @nepherson @renalfellownetwork #NSMC #Nephtwitter #FOAMED #tweetorial @TheSkeletonKG @NSMCInternship
renalfellow.org/2020/05/11/ske…
skeletonkey.group
renalfellow.org/2020/05/11/ske…
skeletonkey.group
1/15
Let's start with a question: Have you ever overshot your goal for hyponatremia correction ?
Let's start with a question: Have you ever overshot your goal for hyponatremia correction ?
2/15
Hyponatremia overcorrection ↗️ is one of the most common dyselectrolytemia which keeps us on our toes.
✅ Let's discuss some strategies to prevent overcorrection ↗️
Hyponatremia overcorrection ↗️ is one of the most common dyselectrolytemia which keeps us on our toes.
✅ Let's discuss some strategies to prevent overcorrection ↗️
3/15
In a patient with high risk for ODS what are your goals of sodium correction in a 24 hour period for chronic hyponatremia ?
In a patient with high risk for ODS what are your goals of sodium correction in a 24 hour period for chronic hyponatremia ?
4/15
This is a tricky question
⏳In a 24 hour period;
🔹️The goal for correction is 4-6 mEq/L (expert opinion)
amjmed.com/action/showPdf…
🔸️While the limit for correction is ≤ 8 mEq/L
ncbi.nlm.nih.gov/pubmed/29295830
This is a tricky question
⏳In a 24 hour period;
🔹️The goal for correction is 4-6 mEq/L (expert opinion)
amjmed.com/action/showPdf…
🔸️While the limit for correction is ≤ 8 mEq/L
ncbi.nlm.nih.gov/pubmed/29295830
5/15
Do you prefer a specific strategy for hyponatremia correction ?
cjasn.asnjournals.org/content/clinja…
Do you prefer a specific strategy for hyponatremia correction ?
cjasn.asnjournals.org/content/clinja…
6/15
Proactive strategy or using the DDAVP clamp;
📌Done at the outset of sodium correction in patients with sodium < 120 mEq/L and high risk of overcorrection
⚡How : DDAVP 2-4 mcg IV Q6-8h AND NaCl 3% 1-1.5 mL/kg IV over 6 hours (≈↑PNa by 1 mEq/L over 6 hours)
Proactive strategy or using the DDAVP clamp;
📌Done at the outset of sodium correction in patients with sodium < 120 mEq/L and high risk of overcorrection
⚡How : DDAVP 2-4 mcg IV Q6-8h AND NaCl 3% 1-1.5 mL/kg IV over 6 hours (≈↑PNa by 1 mEq/L over 6 hours)
7/15
The strategy has been described as an easy to remember “rule of sixes,”: “six a day makes sense for safety; so six in six hours for severe sx’s (symptoms) and stop.”
amjmed.com/action/showPdf…
The strategy has been described as an easy to remember “rule of sixes,”: “six a day makes sense for safety; so six in six hours for severe sx’s (symptoms) and stop.”
amjmed.com/action/showPdf…
8/15
Reactive Strategy;
📌When - Worrisome PNa trajectory:
•PNa achieved goal of 4-6 mEq/L
•UOP > 1 mL/kg/h
⚡How : DDAVP 2-4 mcg IV Q6-8 or or D5W to match UOP cc per cc
Reactive Strategy;
📌When - Worrisome PNa trajectory:
•PNa achieved goal of 4-6 mEq/L
•UOP > 1 mL/kg/h
⚡How : DDAVP 2-4 mcg IV Q6-8 or or D5W to match UOP cc per cc
9/15
Rescue Strategy;
📌As the name suggests , sodium has already been overcorrected by > 8 mEq/L in a 24 hour period.
⚡How: DDAVP 2-4 mcg IV Q6-8h and D5W 3 mL/kg/hr IV over 2 hours(≈↓PNa by 1 mEq/L)
ncbi.nlm.nih.gov/pmc/articles/P…
Rescue Strategy;
📌As the name suggests , sodium has already been overcorrected by > 8 mEq/L in a 24 hour period.
⚡How: DDAVP 2-4 mcg IV Q6-8h and D5W 3 mL/kg/hr IV over 2 hours(≈↓PNa by 1 mEq/L)
ncbi.nlm.nih.gov/pmc/articles/P…
10/15
In spite of these strategies Hyponatremia management is always perplexing. Some caveats to remember while using DDAVP clamp are:
📌Limit oral fluid intake as this can exacerbate hyponatremia
In spite of these strategies Hyponatremia management is always perplexing. Some caveats to remember while using DDAVP clamp are:
📌Limit oral fluid intake as this can exacerbate hyponatremia
11/15
📌 IV Medications formulated in D5W should be avoided while using DDAVP
📌Potassium supplementation should be taken into account when correcting PNa as potassium is osmotically equivalent to sodium (e.g. 1 mEq of KCl is roughly equivalent to 2 mL of NaCl 3%)
📌 IV Medications formulated in D5W should be avoided while using DDAVP
📌Potassium supplementation should be taken into account when correcting PNa as potassium is osmotically equivalent to sodium (e.g. 1 mEq of KCl is roughly equivalent to 2 mL of NaCl 3%)
12/15
Let's summarize the discussed strategies
Let's summarize the discussed strategies
13/15
Read an excellent review of "Outcomes in Severe Hyponatremia Treated With and Without Desmopressin"
pubmed.ncbi.nlm.nih.gov/29061503/?from…
@Nephjc nephjc.com/news/ddavpclam…
Read an excellent review of "Outcomes in Severe Hyponatremia Treated With and Without Desmopressin"
pubmed.ncbi.nlm.nih.gov/29061503/?from…
@Nephjc nephjc.com/news/ddavpclam…
14/15
Lets revisit our scenario again. In a patient with high risk for ODS what are your goals of sodium correction in a 24 hour period for chronic hyponatremia?
Lets revisit our scenario again. In a patient with high risk for ODS what are your goals of sodium correction in a 24 hour period for chronic hyponatremia?
15/15
So finally how do you correct Hyponatremia ?
PS: Despacito = Slowly !!
So finally how do you correct Hyponatremia ?
PS: Despacito = Slowly !!
