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…
Hyponatremia correction; rule of 6s
Profound hyponatremia of around 100mEq/L or less is a double-edged sword- it’s got to be treated but can be terrifying to treat. The University of Rochester shared their protocol for controlled correction of severe hyponatremia with AJKD in…
ACE-inhibitor induced hyponatremia
I’ve always been skeptical about ACE inhibitors as a cause of hyponatremia, despite there being almost 20 case reports of this complication in the literature. Given the fact that so many patients I see are taking an ACE…
Minocycline for the prevention of osmotic demyelination in hyponatremia
There’s a reason that 3 the 10 of the most frequently accessed in “Up to Date” articles relate to the management of hyponatremia. It makes doctors nervous, and I think the main reason for this is the threat…
Drug-induced hyponatremia
When reviewing a consult patient with hyponatremia, the first thing I look at is the medication list to see if the culprit is to be found there. Along with the usual suspects – diuretics, NSAIDs, SSRIs and anti-convulsants,…
Board question of the week: Water-1
A 40-year-old woman is rushed to ER for change in mental status. She has a history of multiple sclerosis and alcohol abuse. On arrival to ER, she exhibits 3 stereotyped, tonic-clonic seizure that resolve with ativan. The initial…
Cisplatin induced hyponatremia; looking deeper
Cisplatin based therapy for the treatment of solid organ tumors is commonly associated with several renal abnormalities including; *hypokalemia*hypomagnesemia*hypocalcemia*hypophosphatemia*fanconi-like syndrome*acute kidney injury We have all seen these complications on the renal consult service at least once. However, less…
Cerebral salt wasting: is it all in the head?
I recently saw a patient in clinic who had sustained a head injury and developed hyponatremia that persisted after discharge. In his chart was a great deal of debate over the cause of his hyponatremia: SIADH or cerebral…
Endocrine and thiazide-induced hyponatremia
We have all been taught that before making the diagnosis of SIADH, we have to ensure that the patient has normal adrenal and thyroid axes. Why is this so important and how do thyroid and adrenal dysfunction cause…
Diagnosing Reset Osmostat
The “reset osmostat” is a cause of hyponatremia, sometimes considered a variant of SIADH, in which the kidney retains its ability to appropriately concentrate and dilute the urine; however, the threshold for ADH secretion is reset downward. That…