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6. What are the basic principles in the treatment of hyponatremia ?

6. What are the basic principles in the treatment of hyponatremia ?. Hyponatremia. Goals of therapy To raise the plasma Na + concentration by restricting water intake and promoting water loss To correct the underlying disorder. Treatment. Mild asymptomatic hyponatremia

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6. What are the basic principles in the treatment of hyponatremia ?

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  1. 6. What are the basic principles in the treatment of hyponatremia?

  2. Hyponatremia • Goals of therapy • To raise the plasma Na+ concentration by restricting water intake and promoting water loss • To correct the underlying disorder

  3. Treatment • Mild asymptomatic hyponatremia • Generally of little clinical significance and requires no treatment • Asymptomatic hyponatremia associated with ECF volume contraction • Na+ repletion isotonic saline • Restoration of euvolemia removes the hemodynamic stimulus for AVP release

  4. Treatment • Hyponatremia associated with edematous states • Have increased total body water that exceeds the increase in total body Na+ content • Restriction of Na+ and water intake, correction of hypokalemia, and promotion of water loss in excess of Na+

  5. Treatment • Acute or severe hyponatremia (plasma Na+ concentration <110–115 mmol/L) • Tends to present with altered mental status and/or seizures • Requires more rapid correction • Treated with hypertonic saline

  6. Rate of Correction • depends on the absence or presence of neurologic dysfunction

  7. 7. What is the complication of the rapid correction of the hyponatremia?

  8. Osmotic demyelination syndrome (ODS) •  Follows too-rapid correction of hyponatremia • Neurologic disorder characterized by flaccid paralysis, dysarthria, and dysphagia • Diagnosis is usually suspected clinically and can be confirmed by appropriate neuroimaging studies • No specific treatment for the disorder • Associated with significant morbidity and mortality

  9. Osmotic demyelination syndrome (ODS) • Chronic hyponatremia • Most susceptible to ODS, since their brain cell volume has returned to near normal as a result of the osmotic adaptive mechanisms • Administration of hypertonic saline to these individuals can cause sudden osmotic shrinkage of brain cells

  10. Osmotic demyelination syndrome (ODS) • Risk factors • Prior cerebral anoxic injury • Hypokalemia • Malnutrition, especially secondary to alcoholism

  11. 8. What intravenous fluid would you use? At what rate should it be given?

  12. Correction of Sodium Deficit A 53kg woman with plasma Na concentration of 123 meq/L • Sodium Deficit = 318 meq • O.9% NaCl = 154meq/L • Volume of 0.9% NaCl needed: • At 0.5 meq/L/hr, a correction of 12 meq (135-123) should be done over 24 hours. • Rate of infusion:

  13. Reference • Harrison’s Principles of Internal Medicine, 17th ed.

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