Sodium abnormalities Flashcards
3 things to check first for a patient with hyponatremia
Hyperglycemia
Hyperproteinemia
Hyperlipidemia
Difference between acute and chronic hyponatremia
48 hours
Emergent hypertonic saline dose
100 mL 3% saline over 10 minutes
repeat if needed to get 4-6 meq increase over a few hours
Max 3 doses
Urgent hypertonic saline dose
50 ml 3% saline given slowly
Desmopressin dose for hyponatremia
1-2 mcg IV q6-8 h x 24-48 hours
3 reasons to treat hyponatremia emergently
Acute hyponatremia
Symptomatic hyponatremia (neuro sxs)
Intracranial pathology with mild to moderate symptoms
Complication from aggressive correction of hyponatremia
Osmotic demyelination syndrome
Onset of osmotic demyelination syndrome after rapid correction of hyponatremia
2-6 days
Sodium correction goal to avoid osmotic demyelination syndrome in hyponatremia
< 9 meq in a 24h period
If emergent, can do 4-6 meq in hours, then very slowly to < 9 from there
What is the formula for free water deficit
% body water x mass (kg) x (current Na - ideal/ideal)
0.5% for men
0.4% for women
Correction rate for fluid for acute hyponatremia
3-6 ml/kg/hour
Correction rate for fluid for chronic hypernatremia
1/4 ml/kg/hour
Should you correct hypernatemia
Only in patients without thirst or who can’t drink fluids
What is the most common cause of chronic hypernatremia without thirst
hypothalamic disease
Formula for free water deficit
Current TBW x (current sodium/140) = Restored TBW
Deficit = Restored TBW - Current TBW
