You are in for a treat as Dr. Joel Topf, aka @kidney_boy, gives us the low down on hyponatremia. Dr. Topf discusses this condition in a way that is helpful for nurses by reviewing clinical concepts without getting into unneeded nitty gritty.
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Important clinical concept: Serum sodium is measuring the amount of sodium in the body in relation to the amount of water. Just because a patient it hyponatremic doesn’t mean their overall sodium levels are low.
Types of Hyponatremia
Hyponatremia is categorized by the overall volume status of the patient.
The problem with these patients is that they are not producing enough urine. An isotonic fluid bolus will often fix the hyponatremia.
Ex: CHF, cirrhosis
There is an overall excess amount of sodium in the body, however, there is little urine output.
Ex: SIADH, excessive water intake (psychogenic polydipsia, water drinking contents), beer potomania/tea-and-toast syndrome, iatrogenic
Treatment for SIADH
- Fluid restrictions. Dr. Topf points out that this method is often ineffective.
- Hypertonic saline. Saved for emergent cases, when there is concern for seizures. Presents risk of osmotic demyelination syndrome (ODS).
- Sodium, Potassium, or Urea tabs. The goal with these is to increase urine volume, not to replace electrolytes
- Tolvaptan. Blocks ADH. Very effective; very expensive.
- Loops Diuretics. Increase urine output, thus increasing serum sodium concentration.
Conflicts of Interest from Dr. Joel Topf
“Takeda Oncology made a donation to MM4MM the program that took me to Mount Everest in 2018.
In 2020, I participated in multiple advisory boards for Bayer. I am also part of subgroup advising them on social media strategies.
In June 2020, I participated in an advisory board for Tricida.