Hyponatremia 2010 - American College of Physicians：低钠血症2010 -美国医科大学.pptVIP

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Hyponatremia 2010 - American College of Physicians：低钠血症2010 -美国医科大学.ppt

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Hyponatremia 2010 - American College of Physicians：低钠血症2010 -美国医科大学

* Teaching Points: ?1)????? The evaluation of mixed acid base disorder. 2)????? Review the Winter’s equation. 3)????? Review the delta gap. 4)????? Develop 2 potential causes for this acid base picture. * Teaching Points: ?1)????? The evaluation of mixed acid base disorder. 2)????? Review the Winter’s equation. 3)????? Review the delta gap. 4)????? Develop 2 potential causes for this acid base picture. * Teaching Points: ?1)????? The evaluation of mixed acid base disorder. 2)????? Review the Winter’s equation. 3)????? Review the delta gap. 4)????? Develop 2 potential causes for this acid base picture. * Teaching Points: ?1)????? The evaluation of mixed acid base disorder. 2)????? Review the Winter’s equation. 3)????? Review the delta gap. 4)????? Develop 2 potential causes for this acid base picture. * Teaching Points: ?1)????? The evaluation of mixed acid base disorder. 2)????? Review the Winter’s equation. 3)????? Review the delta gap. 4)????? Develop 2 potential causes for this acid base picture. Additional lab data Urine osm – 350 Medications Nefazodone (Serzone) Olanzapine (Zyprexa) Diagnosis Increased ADH – secondary to her SSRI Exacerbated by polydipsia (despite olanzapine) Outpatient hyponatremia The myth of asymptomatic hyponatremia Asymptomatic hyponatremia Sodium 115 - 132 Not truly asymptomatic Odds ratio for falls – 67! Careful testing shows Decreased attention Unstable gait Changes mild alcohol intake Acute hyponatremia treatment Seizures Altered mental status Neurogenic pulmonary edema Treatment of acute hyponatremia Indications for very aggressive treatment Active seizures Respiratory failure Indications for aggressive treatment Seizures (not active) Decreased mental status Headache, nausea and vomiting Very aggressive treatment for hyponatremia Bolus 100 cc of 3% NaCl over 10 minutes Can repeat 1 or 2 times until clinical improvement or Na increased 2-4 mEq/l Then start aggressive treatment Aggressive treatment for h