Linked: Sodium and Potassium
Emily mentioned in her recent post on the Rule of 6s that potassium administration needs to be taken into account when correcting the plasma sodium in cases of hyponatremia. Why is this the case? When potassium is given…
Sodium – interpretation of measurements Part II
Ok, so here is the brief review of the various clinical methods of detecting sodium concentration (as I understand it): Flame photometer The older flame photometer method measured the concentration of sodium in plasma. The preparation of the…
Pitfalls with paraproteins
We were recently consulted on a patient with a history of multiple myeloma who had developed severe hypercalcemia and acute renal failure. The calcium on admission was 15mg/dl (albumin 2.6) and the patient was treated aggressively with IV…
Sodium – interpretation of measurements
Sodium is the most abundant extracellular cation in humans. The concentration in the extracellular fluid is highly influenced by the amount of fluid it is dissolved in – the reason why we always say that most low sodium…
Urine electrolytes in metabolic alkalosis
No time like the present for a quick review of urine electrolytes. Is there any such thing as a ‘normal’ urine sodium? Not really – like all great answers in medicine, ‘it depends’. In general, in patients who…
What about the Bicarb?
In our dialysis unit, the standard HCO3 bath is 35 mmol/L. While it is adjustable, it is rarely changed but recently we had a patient with a pre-dialysis HCO3 of 12 which got me thinking about what constitutes…
Hypokalemia and deafness
I attended a research seminar last week given by the discoverer of EAST syndrome. This a rare, autosomal recessive condition in which children present with Epilepsy, Ataxia, Sensorineural deafness and Tubulopathy. It was a fascinating lecture detailing the…
Cool New Cell Paper Demonstrates Molecular Basis for Thyroxic Hypokalemic Periodic Paralysis
The periodic paralysis syndromes are characterized by episodic attacks of acute muscle weakness, typically due to rapid fluxes in the serum potassium concentration, based on an abnormality in intracellular potassium shift. While there have been several instances of…
Hypercalcemia of Malignancy
Cancer-associated hypercalcemia is the #1 cause for hypercalcemia in the inpatient setting (in the outpatient setting, the main cause is primary hyperparathyroidism). In general, hypercalcemia of malignancy portends a poor prognosis, and there are three main mechanisms by…
SGK1, Hypertension and the Metabolic Syndrome
I was recently asked the mechanism by which insulin resistance causes sodium retention and hypertension, and had to lie. Here’s what I should have said. Serum and glucocorticoid-inducible kinase 1 (SGK1) is an enzymatic central orchestrator of many…