[This is the final post in the five-part series covering some important and often overlooked (and under-published) issues and concepts in the management of severe hyponatremia. While this is not, by any means, an exhaustive discussion of the…
PART 4: CONTROL ISSUES 1. Losing Control: In the preceding posts, I explained how sudden emergence of water diuresis as the predominant mechanism by which rapid overcorrection of serum sodium happens in cases of severe chronic hyponatremia. Few…
PART 3: THE DANGERS OF “DEPLETION” In my previous post concerning chronic severe hyponatremia, I explained how over corrections of serum sodium of large magnitude required a dilute large volume diuresis, often precipitated by resolution of a transient…
PART 2: THE PEE IS THE KEY I mentioned in the previous post that severe hyponatremia is multifactorial and that the contributing etiological factors in any given case may be transient and reversible. In this post I would…
INTRODUCTION: Severe chronic hyponatremia (<120 mEq/L) remains the #1 reason nephrologists lose sleep on call nights and rightly so. The fear of overcorrection and the risk of central pontine myelinolysis (CPM) or osmotic demyelination syndrome (ODS), however uncommon…
Recently a 65-year-old female was referred to an ED in the state of Missouri complaining of fevers, chills, headache, diarrhea and vomiting occurring over the last week. 3 weeks prior she had received an orthotopic liver transplant. Her…
Urea is a hyponatremia treatment long forgotten in the United States. Chronic SIADH is usually managed either by vaptans or a combination of fluid restriction, salt and furosemide. However, vaptans are very expensive and few patients can afford…
Recently, we were asked to see a patient on the consult service with a rising creatinine, a BUN of close to 200 and decreased urine output. The patient was a diabetic who had an STEMI several months previously…
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…
