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  #1  
Old 03-29-2011
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Question Management of hyponatremia

I'm getting confused about hyponatremia.

USMLE-WORLD ignores the Na level, and just says:
  • asymptomatic cases: only needs water restriction.
  • symptomatic cases: needs hypertonic (3%) saline in a slow rate.
While Kaplan Qbank suggests looking at the Na level, and says:
  • mild hyponatremia (135-120): water restriction.
  • moderate hyponatremia (120-110): normal saline + loop diuretic.
  • severe hyponatremia (<110): hypertonic (3%) saline.
Which is more accurate? UW also mentions we shouldn't ever give normal saline to a patient with hyponatremia as it may exacerbate the condition.

This is driving me nuts

Anyone?
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Old 03-29-2011
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I was reading this article
http://emedicine.medscape.com/article/767624-overview

What Kaplan mentioned is more correct than what UW said, so follow Kaplan
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  #3  
Old 03-30-2011
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i agree with kaplan q bank...coz many assymptomatic cases can have moderate hyponatremia ...the issue is how fast has hyponatremia developed.....

if hyponatremia developed in days then obviously only water restriction wud not help we need to give NS and loop diuretic....

if hyponatremia is acute.. in hrs or a day...then we have to correct it acutely with hypertonic saline....

moreover kaplan q bank says wt we have in our kaplan lecture notes so i agree with it..u cn find it in renal and electrolytes chapter.....

hope this helps...
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Old 03-31-2011
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It really depends on the type/cause of hyponatremia!

Basically 3 different types based on fluid status
1) hypervolemic hyponatremia
2) euvolemic
3) hypovolemic

Disagree with UW on this!
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Old 04-01-2011
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The most important consideration is the patients current clinical situation- If the person is in seizures then the sodium level has to be corrected about 1/2meq/hour . If the patient is stable but sodium is on the wrong side od 120, that would be an indication to actively raise the sodium level 0.5 meQ/hr... if the hyponatremia is really mild -and patient is also fine then simple water restriction.


The crux of the issue ( which can be tested ) is that patients may show a range of symptoms at a range of sodium levels, we shouldnt do "water restriction" on a patient who is showing CNS signs - whichever book it might say. so UW is absolutely spot on.. also Dr. Conrad Fischer agrees with this in his IM lectures
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Old 04-01-2011
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You won't restrict fluid in patient with hypovolemic hyponatremia, would you?

Quote:
Originally Posted by drarnab View Post
The most important consideration is the patients current clinical situation- If the person is in seizures then the sodium level has to be corrected about 1/2meq/hour . If the patient is stable but sodium is on the wrong side od 120, that would be an indication to actively raise the sodium level 0.5 meQ/hr... if the hyponatremia is really mild -and patient is also fine then simple water restriction.


The crux of the issue ( which can be tested ) is that patients may show a range of symptoms at a range of sodium levels, we shouldnt do "water restriction" on a patient who is showing CNS signs - whichever book it might say. so UW is absolutely spot on.. also Dr. Conrad Fischer agrees with this in his IM lectures
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Old 04-01-2011
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Quote:
Originally Posted by 1TA2B View Post
You won't restrict fluid in patient with hypovolemic hyponatremia, would you?
Yes you are correct, i shouldnt have made the offhand comment like that. Ofcourse we dont water restrict a person who has lost fluid by running around or diarrhea or whatever!! ..The point i wanted to make is that the treatment should be according to the SEVERITY of the condition.

Hypoosmolar hyponatremia also has two types of treatment (NMS surgery 5/ed page 7) - Either NS .. but also salt replacement (HS) .. here again severity is guiding the therapy.

Anyway im no authority neither do i claim to be.. my sole objective is to get the questions right on CK...watever works..
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Old 04-01-2011
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Question

What about the choice in between: normal saline + loop diuretic ? When should we really give that?
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Old 04-01-2011
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No worries! I don't feel offended.
I just made a point for our MLE fellows just to be careful!
I agree that it depends on the speed/severity and underlying cause of the process really!
Thanks

Quote:
Originally Posted by drarnab View Post
Yes you are correct, i shouldnt have made the offhand comment like that. Ofcourse we dont water restrict a person who has lost fluid by running around or diarrhea or whatever!! ..The point i wanted to make is that the treatment should be according to the SEVERITY of the condition.

Hypoosmolar hyponatremia also has two types of treatment (NMS surgery 5/ed page 7) - Either NS .. but also salt replacement (HS) .. here again severity is guiding the therapy.

Anyway im no authority neither do i claim to be.. my sole objective is to get the questions right on CK...watever works..
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