The lower the sodium and the faster the fall, the more symptomatic a patient will become. Hyponatremia is a low sodium concentration in the blood. Hyponatremia hyponatremia chronic asymptomatic symptomatic long term management treat etiology water restriction demeclocycline urea v2 receptor antagonist some. Central pontine myelinolysis an overview sciencedirect. Hyponatremia not so fun facts not as asymptomatic as you might think gait instability, falls and fractures for na 124 mmoll renneboog b. Hyponatremia defined as a serum sodium level 150 meql slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Sodium is a major determinant of neuronal size and therefore. Normal saline forms the mainstay of treatment for hypovolemic hyponatremia while 3% nacl and fluid restriction are important for euvolemic hyponatremia. Scribd is the worlds largest social reading and publishing site. May 25, 2000 the new england journal of medicine prostatectomy can cause severe and symptomatic hyponatremia. Sodium and water balance authorstream presentation. Hyponatremia and hypothyroidism commonly coexist because both conditions are common. It is generally defined as a sodium concentration of less than 5 mmoll 5 meql, with severe hyponatremia being below 120.
We would, however, like to raise the following caveat. Hyponatremia or a low blood sodium level can sometimes be corrected before it causes complications. The syndrome beer potomania is used to describe a patient who presents with hyponatremia in. Valacyclovir neurotoxicity and nephrotoxicity in an. Disorders of plasma sodium new england journal of medicine. An 85 yearold male presents to the emergency room with pneumonia. The management of hyponatremia in hiv disease springerlink. Hyponatremia defined as serum na less than 5 mmoll acute hyponatremia. Water balance medical specialties clinical medicine. Hyponatremia management pearls 1 linkedin slideshare. Hyponatremia may be euvolemic, hypovolemic or hypervolemic. Reflecting the composition of the irrigant, the resultant hyponatremia can be either. Hyponatremia, defined as a decrease in serum sodium below 6 mmoll, is a common occurrence in both inpatients and outpatients and can be found in up to 15% of the general hospital. He has been febrile for several days and has had a cough productive of yellow sputum.
Whereas hypernatremia always denotes hypertonicity, hyponatremia can be associated with. The administration of acyclovir antiviral therapy has been a treatment option for varicella zoster virus infection. There are two different, but not mutually exclusive, ways to arrive at a clinical diagnosis in a patient with hyponatraemia and to design appropriate therapy. Hyponatremia defined as serum na less than 5 mmoll mild hyponatremia. For global readers, a calculator to convert laboratory. Hypotonic hyponatremia in sodiumretentive states involves.
In commenting on hyponatremia secondary to the absorption of sodiumfree irrigant solutions from an operative site, adrogue and madias may 25 issue1 refer only to men who are. Correspondence volume 108, issue 2, p180181, february 01, 2000. Hypotonic hyponatremia in sodiumretentive states involves expansion of both compartments. Downloaded from at the university of illinois on february 8, 2018.
The serum sodium concentration and thus serum osmolality are closely controlled by water homeostasis, which is mediated by thirst, arginine vasopressin, and the kidneys. Hyponatremia nejm 2000 pdf natremia always denotes hypertonicity, hyponatremia downloaded from. An unusual syndrome of hyponatremia was described in beer drinkers dating back to the early 1970s. A recent article scrutinized the use of the formula in both hypo and hypernatremic patients. Hypernatremia is common in critical care, especially in severely burned patients. Hyponatremia and hypernatremia are classified based on volume. Sodium and fluid management in the brain injured patient directly impacts cerebral edema and cerebral perfusion pressure. Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 6 mmol per liter. Proper interpretation of the various laboratory tests. Its occurrence has been linked to increased mortality. Causes of hypernatremia involve a net gain of sodium or a. This coexistence, however, may not necessarily be causal. Ppt hyponatremia powerpoint presentation free to view.
Clinical practice guideline on diagnosis and treatment of. Hyponatremia upon presentation to the emergency department. Nejm journal watch concise summaries and expert physician commentary that busy clinicians need to enhance patient care. We define acute hyponatraemia as hyponatraemia that is documented to exist england journal of medicine downloaded from nejm. Diagnostic approach to a patient with hyponatraemia. Hyponatremia upon presentation to the emergency department the need for urgent neuroimaging studies. The adroguemadias formula revisited american society of.
Click on the pdf icon above to download this diagnosticmanagement tree on hyponatremia. Of the 204 patients with hyponatremia in this study, only 10 received hypertonic saline, a. Impact of hyponatremia journal of hospital medicine. Hyponatremia is an important and common clinical problem. Ubaidur rahaman internist and critical care specialist 2. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. The high prevalence of hyponatremia in hospitalized patients has been recognized for decades. Central pontine myelinolysis is mainly an iatrogenic disorder, and its appearance coincided with the widespread use of intravenous therapy for correction of fluid and electrolyte disorders. Water balance free download as powerpoint presentation. Seminars in nephrology 2009 management of hyponatremia in the icu. A disruption in the water balance is manifested as an abnormality in the serum sodium concentration hypernatremia or hyponatremia.