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![• Total sodium deficit (mEq) = [total body water
in L)] × [(desired Na+) - (actual Na+)] Na+ is in
mEq/L](https://image.slidesharecdn.com/hypona-141110145156-conversion-gate01/75/Hypo-na-26-2048.jpg)
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Hypo na
This document discusses hyponatremia (low sodium levels in blood). It begins by defining relevant terms like osmolality and normal ranges. It then notes that hyponatremia is most common in females, elderly, and hospitalized patients. The diagnosis involves assessing volume status, serum osmolality, and urine sodium and osmolality. Treatment depends on the cause but aims to slowly correct sodium levels to prevent central pontine myelinolysis, a severe neurological condition.
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Hypo na
- 2. Khalid Shawkey Internistand Nephrologist ICU unit Internal Medicine Department Zagazig University Hospitals
- 4. • Normal serumsodium 135-145 mEq/l • Osmolality :- number of osmoles per kg of solvent • Osmolarity :- number of osmoles per litre of solution • Normal plasma osmolality 280-290 mmol/l • Normal urine osmolality 400-500mmol/l
- 5. Plasma Osmolality, Calculation • normally ranges between 280 and 290 mmol/L 5
- 6. Osmolar gap •The difference between measured and calculated plasma osmolality • A value greater than 10 mosm/kg H2O is considered elevated and reflects the presence of unmeasured solutes
- 9. EPIDEMIOLOGY • Hyponatremiais the most common electrolyte disorder • The disorder is more frequent in females, the elderly, and in people who are hospitalized. • A hospital incidence of 15–20% is common, while only 3–5% of people who are hospitalized have a serum sodium level (salt blood level) of less than 130 mEq/L. • Hyponatremia has been reported in up to 30% of elderly patients in nursing homes and is also present in approximately 30% of depressed patients on selective serotonin reuptake inhibitors
- 19. Effects of Hyponatremiaon the Brain and Adaptive Responses.
- 20. Diagnosis • Urineosmolality:-Urine osmolality helps differentiate between conditions associated with impaired free-water excretion and primary polydipsia. A urine osmolality greater than 100 mOsm/kg indicates impaired ability of the kidneys to dilute the urine.
- 21. • Serum osmolality:-Serumosmolality readily differentiates between true hyponatremia and pseudohyponatremia secondary to hyperlipidemia, hyperproteinemia, or hypertonic hyponatremia associated with elevated glucose, mannitol, glycine (posturologic or postgynecologic procedure), sucrose, or maltose (contained in IgG formulations).
- 22. • Urinary sodiumconcentration:-Urinary sodium concentration helps differentiate between hyponatremia secondary to hypovolemia and syndrome of inappropriate antidiuretic hormone secretion (SIADH). With SIADH (and salt-wasting syndrome), the urine sodium is greater than 20- 40 mEq/L. With hypovolemia, the urine sodium typically measures less than 25 mEq/L. However, if sodium intake in a patient with SIADH (or salt-wasting) happens to be low, then urine sodium may fall below 25 mEq/L.
- 23. treatment I. Determinethe rate of correction Acute hyponatremia Rapid correction at a rate of 1 to 2 mEq/L/hr until plasma Na+ 120 mEq/L Chronic hyponatremia Slow correction at a rate of 0.5 mEq/L/hr until plasma Na+ 120 mEq/L II. Determine the mode of correction Hypovolemic hyponatremia Saline Euvolemic hyponatremia Fluid restriction; furosemide alone or with saline to replace urine N+ losses Demeclocycline in SIADH if above is insufficient Hypervolemic hyponatremia Treat underlying disease Fluid restriction Furosemide alone or with saline to replace urine Na+ losses if above is unsuccessful
- 25. • Total bodywater (L) = (body weight in kg) × (correction factor) Correction factor is 0.6 for children and nonelderly men, 0.5 for elderly men and nonelderly women, and 0.45 for elderly women.
- 26. • Total sodiumdeficit (mEq) = [total body water in L)] × [(desired Na+) - (actual Na+)] Na+ is in mEq/L
- 27. Sodium concentration inIV fluids • 0 mEq/L in 5% dextrose in water • 77 mEq/L in 0.45% saline • 154 mEq/L in 0.9% saline • 513 mEq/L in 3% saline Total liters IV fluids needed = total Na+ deficit (mEq)/Na+ concentration in IV fluid (mEq/L)
- 28. Pharmacologic treatment •demeclocyclines:- which interferes with ADH action at the collecting tubule; hypersensitivity and nephrotoxicity are the limitations. • urea, which acts as an osmotic diuretic; palatability and azotemia limit the use • vasopressin receptor antagonists, which interfere with ADH action. Conivaptan is approved for short-term parenteral use in euvolemic and hypervolemic hyponatremia. Incomplete data on chronic use and interactions with cytochrome P450-metabolized drugs limit use.
- 29. Central pontine mylinolysis • a severe neurological disease involving a breakdown of the myelin sheaths covering parts of nerve cells . • During treatment of hyponatremia, the serum sodium (salt level in the blood) is not allowed to rise by more than 8 mmol/l over 24 hours. • The lesion is detectable by both CT and MRI
- 31. TAKE HOME POINTS • Symptoms: Usually Na <125 or rapid decline – N/V, headache, lethargy, AMS, seizures, coma • WORK-UP in 3 important steps (V-O-U): – 1) Assess volume status – 2) Assess serum osmolality – 3) Check urine sodium and osmolarity • Treatment varies by etiology, but cautious correction of sodium important to prevent demyelination as fluid leaves the brain