Hyponatremia Updates
By Richard Sterns and Biff Palmer
By Richard Sterns and Biff Palmer
Take home points
1. Make sure you rule out pseudohyponatremia( glycemia, mannitol use, sucrose use)
2. A commonly used agent in our transplant patients that might be sucrose based is IVIG and that can lead to pseudohyponatremia.
3. TURP syndrome leading to hyponatremia is another entity that is missed and non electrolyte water is used so that it doesn’t conduct electricity in these procedure.
4. Treatment of acute hyponatremia is very important, treating promptly is key. There is data that 12meq/day is safe to prevent Osmotic Demylination Syndrome. But going 0.5meq/hour is not required and there is no data. You might need to correct much faster.
5. Rule of 6 to treat acute symptomatic hyponatremia is very important. Correct up to 6meq over first 6 hours and then stop and re assess. Use 3%normal saline.
6. Use of vaptans in acute hyponatremia is still in early stages. Few cases reported of using it.
7. Risk factors for ODS are age, alcohol, low solute intake and chronic hyponatremia and correcting too fast is as we all know very dangerous.
8. Using 3%NS and starting simultaneous DDAVP as well in high risk patients who present with acute symptomatic hyponatremia might be a good way to prevent overcorrection.
1. Make sure you rule out pseudohyponatremia( glycemia, mannitol use, sucrose use)
2. A commonly used agent in our transplant patients that might be sucrose based is IVIG and that can lead to pseudohyponatremia.
3. TURP syndrome leading to hyponatremia is another entity that is missed and non electrolyte water is used so that it doesn’t conduct electricity in these procedure.
4. Treatment of acute hyponatremia is very important, treating promptly is key. There is data that 12meq/day is safe to prevent Osmotic Demylination Syndrome. But going 0.5meq/hour is not required and there is no data. You might need to correct much faster.
5. Rule of 6 to treat acute symptomatic hyponatremia is very important. Correct up to 6meq over first 6 hours and then stop and re assess. Use 3%normal saline.
6. Use of vaptans in acute hyponatremia is still in early stages. Few cases reported of using it.
7. Risk factors for ODS are age, alcohol, low solute intake and chronic hyponatremia and correcting too fast is as we all know very dangerous.
8. Using 3%NS and starting simultaneous DDAVP as well in high risk patients who present with acute symptomatic hyponatremia might be a good way to prevent overcorrection.
No comments:
Post a Comment