Malaise Headache Lethargy Seizures Coma Respiratory depression Cell water K Organic solutes 13 CSF 52 vs 13 30 days 18 vs 07 74 vs 46 37 vs 15 8 10 mmolL ID: 776599
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Slide1
Low salt
BM 2019
MMC
Slide2Slide3Nausea
MalaiseHeadacheLethargySeizuresComaRespiratory depression
Cell water K+Organic solutes (1/3)
CSF
Slide45.2 vs 1.3% @ 30 days
1.8% vs 0.7%
7.4% vs 4.6%
3.7% vs 1.5%
Slide5Slide6Slide78 – 10 mmol/L
in
24 hours
18 in 48 hours
Slide8Primary Polydipsia overwhelms kidney
Slide9Slide10Tonicity maintained = sodium per Liter of plasma is reduced (but normal per liter of plasma water)
Slide11Slide12Slide13Mild
Moderate
Severe
130 -134 mEq/L
120 – 129 mEq/L
< 120 mEq/L
Acute or Chronic
Symptom Severity
24 - 48 hours
Seizures Obtunded Coma Respiratory Arrest
Slide14Hypotonic hyponatremia
Oedematous
Heart failureCirrhosisEnd stage renal disease
Hypovolemia
Low urine Na < 25
Low urine Na > 40
GIT loss‘Third space’Diuretics
Urine Chloride >25DiureticsPrimary adrenal insufficiency‘Cerebral salt wasting’Urine chloride < 25VomitingAssociated M. Alk
Slide15Euvolemic
Hypotonic hyponatremia
Low urine sodium < 25Low urine osmolality < 100
Primary polydipsiaBeer potomaniaRapid correct of hypovolemia with salineReversal of SIADH after stopping drugGC replacement in adrenal insufficiencySurreptitious diuretic use
High urine sodium > 40High urine osmolality > 100
SIADH
Severe hypothyroidism
Cortisol deficiency
Slide16Chlorpropamide
Carbamazepine
Oxcarbazepine
IV cyclophosphamide
SSRIVincritineHaloperidolValproateNSAIDSAlpha interferonAmiodaroneMTXopiates
Slide17< 105
Hypokalemia
Alcoholism
Malnutrition
Liver disease
Premenopausal women
Young children
Slide188-10 mEq/L in 24 hours Acute Severe: 4-6 mEq/L will reverse most severe symptoms in 6 hours 50-100ml aliquots of 3% Saline over 10 minutes Max 300mls
ABC Stop offending drugsReverse the cause Treat hypovolemia with saline or 3% saline if severeTreat seizures with benzo
6/6
8/24