Labs on presentation: Na 117, K 1.5, Normal renal function. Exam
consistent with volume depletion. EKG changes consistent with hypokalemia. Hyponatremia is asymptomatic
Treatment?
A. Treat hyponatremia first and then hypokalemia
B. Treat hyponatremia and hypokalemia simultaneously
C. Treat hypokalemia first and then hyponatremia
Any thoughts? What would you do?
C, but i believe that, in practice, we'd probably end up doing B.
ReplyDeleteI would think treat both. As you improve distal tubular flow with saline , hypokalemia can worsen
ReplyDeleteHow about KCl, NaCl and DDAVP with water restriction.
ReplyDeleteTreat hypokalemia first.
ReplyDeleteIn this case the hyponatremia may be at least partly explained by the huge deficit in total body potassium stores, thus causing intracellular shift of sodium in exchange for potassium. Given that this patient is asymptomatic, option C is probably the safest. Aggressive repletion of K w/150-200 mEq daily for 2-3 days will be necessary to replete his K and the patient's Na may slowly improve aswell.
ReplyDeleteTreat hypokalemia with IV KCL (ECG abnormalities make it urgent). Repleting volume would probably take care of hyponatremia.
ReplyDeletePatient should only be treated for Hypokalemia first as hypokalemia correction itself will cause improvement in hyponatremia. The theory behind it is with K repletion, there is translocation of K in the cell and Na will move out. Mich. Halperin book has an excellent article on this.
ReplyDelete