#48: Hyponatremia Deconstructed


Manage episode 182959602 series 1345893
By Discovered by Player FM and our community — copyright is owned by the publisher, not Player FM, and audio streamed directly from their servers.

Step up your salt game. We deconstruct hyponatremia with expert tips from our Chief of Nephrology, Dr. Joel Topf aka @kidney_boy aka The Salt Whisperer. Topics include: true versus false hyponatremia, SIADH, tea and toast/beer potomania, safe rates of sodium correction, fluid restriction, salt tablets, IV fluid choice, DDAVP clamps, and more.

Full show notes available at http://thecurbsiders.com/podcast

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Case: 85yo F with anxiety, asthma, HTN (on a CCB), hypothyroidism with TSH of 3 on therapy. Sodium was 128 from previous values 134-137 mg/dL. She is more fatigued than usual.

Time Stamps

00:00 Intro

03:00 Guest interview

06:45 Pick of the week w/Dr. Topf

15:50 Clinical case of hyponatremia

17:18 False hyponatremia normal osmolality

19:04 False hyponatremia high osmolality

20:06 Understanding why osmolality matters

22:58 Workup false hyponatremia

24:15 Recap of discussion so far

25:10 ADH dependent vs independent hyponatremia

26:30 Psychogenic polydipsia

28:45 Renal failure and hyponatremia

29:33 Tea and toast, and Beer Drinker’s potomania

34:42 ADH dependent hyponatremia

37:45 Volume versus osmolality

39:30 Volume status exam

44:44 Additional testing with urine lytes and uric acid

47:00 Treatment for SIADH

52:12 Discussion of the vaptans

57:51 Additional testing in SIADH

62:20 When to admit patient for hyponatremia

63:29 Clinical case of hyponatremia complications

68:26 Fluids and rate of correction

73:06 DDAVP clamp

76:00 Moderate hyponatremia

78:05 Diuretic dosing DOES matter!

81:29 Loop diuretics for SIADH

83:55 Take home points

86:55 Outro

Tags: hyponatremia, salt, sodium, SIADH, ADH, vasopressin, fluids, electrolytes, kidney, nephrology, osmolality, urine, concentration, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

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