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Hyponatremia Dr Mohammed abdelsattar

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D efined as serum Na less than 135meq/l Symptoms are nonspecific and can include mental changes, headache, nausea and vomiting, tiredness, muscle spasms, and seizures . Severe hyponatremia can lead to coma and can be fatal .

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O smolality 2na+glaucose/18+bun/2.8= 285 to 295 T onicity 2na+glaucose/18

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We should differentiate hyponatremia if it is true or false So we should measure Osmolality or tonicity of I blood

Isotonic hyponatremia:

I sotonic hyponatremia It occure when Na is measured in plasma in cases of hyperprotiemia and hypertriglyremia I t should be measured in water using ion speific eletrode L ab error pseudohyponatremia

Hyperosmolar hyponatremia:

H yperosmolar hyponatremia C alled pseudohypoatremia or translocational hyponaremia I n presene of high active osmotic component as high glauose mannitol ethylene W ater cross from ICF to ECF and dillute Na

Correted Na in hyperglyemia:

C orreted Na in hyperglyemia T wo methods B y katz method add 1.6 meq for each 100gm inrease in glauose by hillier method more acurrate add 2.4 meq for each 100gm increase in glauose

Hypotonic hyponatremia:

Hypotonic hyponatremia If hyponatremia is hypotonic we should asses volume status by: Hepatojugular reflux Heart rate Blood pressure Skin turgor History of vomiting diarrhra or diuretic use Or CVP guided

Hypovolemic hyponatremia:

H ypovolemic hyponatremia D ecrease in water but more decrese in Na P t is dehydrated ad there is derease i JVP

Hypovolemic hypoatremic:

H ypovolemic hypoatremic

Hypervolemic hypoatremic:

H ypervolemic hypoatremic I ncrease Na but more increase in water

Hypervolemic hypoatremic:

Hypervolemic hypoatremic

Isovolemic hypoatremia:

Isovolemic hypoatremia N o change in Na M ild inrease in water

Isovolemic hyponatremia:

Isovolemic hyponatremia

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The goal of treatment is to get the patient out of immediate danger (return sodium level to > 120 meq /l). Usually reserved for severe symptomatic hyponatremia (level usually < 115 ). The maximum rate of increase (sodium level) is 2 meq /L/hr . The usual rate is 0.5 to 1 meq /L/hr- - these lower rates help avoid serious CNS complications (cerebral edema, pontine myelinolysis,seizures ) and/or pulmonary edema.  Always verify the infusion rate and the length of infusion based on patient weight and sodium leve

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Calculation of the sodium deficit:  0.6 x weight(kg) x (desired Na - Actual Na+). Use 0.5 for females. Desired Na+= 120-125 meq /l. 

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Example: 70kg male. Na+= 110 meq /l Desired target= 125 meq /l.  [0.6 x 70kg x (125-110)= 630 meq of Na+ needed].  Amount needed to increase serum sodium level by 1 meq /l/hr= 0.6 x 70kg x 1.0= 42 meq /hr (safe rate for this patient).  3%--hypertonic saline contains 513 meq /liter.  Therefore: [desired rate per hr] / 513 x 1000 = infusion rate (ml/hr).  And the total infusion time= [total meq needed] / [ meq /hr]  Desired rate= 42/513 meq x 1000= 82 ml/hr  Infusion time= [630 meq ] / [42 meq /hr] = 15 hrs.  Therefore: Infuse 3% saline at 82 ml/hr for 15 hours.

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