Morning Report: 8/2/2013

Here’s Dr. Youn with today’s Morning Report!

Hyponatremia

Source: Schrier RW and Bansal S. Diagnosis and management of hyponatremia in acute illness. Current Opinion in Critical Care 2008, 14:627-634

SERIOUS COMPLICATIONS: Cerebral edema, seizures, AMS, coma, death, iatrogenic (overcorrection of sodium)

INITIAL MANAGEMENT:

1. ABCs, IV, O2, Monitor, H&P
2. Labs:
   • Serum: electrolytes, osmolality, uric acid (if on diuretics), TSH, cortisol
   • Urine: UA, lytes, osm, urea, creatinine, uric acid (place foley)
3. Treat symptoms (seizures, coma, herniation)
   • 3% hypertonic saline – 100mL over 10-20 minutes (or over 1 hr or 4-6ml/kg/hr), repeat x1 if necessary (100mL will raise Na approx. 2mmol/L)
4. Fluid restriction for euvolemic/hypervolemic; Isotonic hydration if clearly hypovolemic
5. Rule of 6’s: only increase up to 6mEq/L per day.  If patient has severe signs and symptoms, increase up to 6mEq/L within the first 6 hours and then stop.
6. Consider dDAVP and/or D5W if concern for overcorrection; V2 vasopressin receptor antagonists – conivaptan, tolvaptan
7. Osmotic Demyelination Syndrome – symptoms include dysarthria, dysphagia, seizure, AMS, quadriplegia, hypotension
8. Be mindful of repleting potassium – if you replete K, then Na will increase as well

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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

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