Discover and read the best of Twitter Threads about #hyponatremia
Most recents (11)
Can #drinking excess amount of #water lead to death?
1. Water is life-saving and is essential for survival. However, ingestion of excess amounts of water, especially over a short period of time can lead to serious health hazards, including #death.
#MedTwitter #internalmedicine
1. Water is life-saving and is essential for survival. However, ingestion of excess amounts of water, especially over a short period of time can lead to serious health hazards, including #death.
#MedTwitter #internalmedicine
2. How much water is needed on daily basis?
The normal daily requirement of water is 2.5 to 3 liters.
The requirement may be higher in summer months. Requirement also increases during #exercise (due to sweating), during fever, diarrhea or vomiting.
The normal daily requirement of water is 2.5 to 3 liters.
The requirement may be higher in summer months. Requirement also increases during #exercise (due to sweating), during fever, diarrhea or vomiting.
3. Why do some people drink excess amounts of water?
There is a misconception that drinking more water is good for #health.
Some people can drink more water due to #psychiatric illnesses.
#athletes can overestimate fluid loss and drink an excess amount of water.
There is a misconception that drinking more water is good for #health.
Some people can drink more water due to #psychiatric illnesses.
#athletes can overestimate fluid loss and drink an excess amount of water.
Had the privilege of presenting another case to @rabihmgeha and @DxRxEdu on Friday-VMR and it was just mesmerizing hearing them talk through it step by step.
Here are some reflections on the fascinating topic discussed:
CAVE: spoiler alert ‼️
Here are some reflections on the fascinating topic discussed:
CAVE: spoiler alert ‼️
A 60ish M p/w a week of jaundice after Tx w/ bactrim 2 weeks ago. His PMH was significant for T2DM, HLD and he was on a statin and insulin Tx.
PE was notable for marked jaundice w/o signs of cirrhosis and no encephalopathy.
PE was notable for marked jaundice w/o signs of cirrhosis and no encephalopathy.
Labs: CBC wnl, liver tests w/ predominant cholestatic, but also hepatocellular pattern of injury
Na+ 113, SOsm 290, glucose 260, normal kidney function
At that time we found ourselves in the space of
hyponatremia w/ a normal serum osmolarity.
A short 🧵:
Na+ 113, SOsm 290, glucose 260, normal kidney function
At that time we found ourselves in the space of
hyponatremia w/ a normal serum osmolarity.
A short 🧵:
1/🧵Hey #MedTwitter #NephTwitter: 📣 #Tweetorial alert 🚨
DDAVP clamp in #Hyponatremia ❗️
Let’s go for a ride 🚌 and discover together starting with a case!
79 yo female👵🏽 presents with nausea, vomiting and decreased level of consciousness.
Her labs showed a serum Na=109mmol/L
DDAVP clamp in #Hyponatremia ❗️
Let’s go for a ride 🚌 and discover together starting with a case!
79 yo female👵🏽 presents with nausea, vomiting and decreased level of consciousness.
Her labs showed a serum Na=109mmol/L
2/🧵 Isotonic NaCl 🧂 solution was administered and 24 hrs later, her neurological 🧠 symptoms worsened (new hypotonia, tremors and involuntary muscle spasms) . What is happening with our patient?
3/🧵These are complications from overcorrection of the hyponatremia!!
Other findings may include: AMS, dysarthria, dysphagia, seizures, confusion or lethargy. 😩😣🥱
Other findings may include: AMS, dysarthria, dysphagia, seizures, confusion or lethargy. 😩😣🥱
#POCUS #VExUS consult for #hyponatremia. Elderly pt with h/o mitral valve replacement. On Bumetanide, UNa ~70 mmol/L, Uosm ~250🧵
Trace edema, JVD +, feels OK
Calling hemodynamic friends @khaycock2 @ThinkingCC @ArgaizR @msiuba @IM_Crit_ @MDBeni @siddharth_dugar Educate us!
1/ IVC
Trace edema, JVD +, feels OK
Calling hemodynamic friends @khaycock2 @ThinkingCC @ArgaizR @msiuba @IM_Crit_ @MDBeni @siddharth_dugar Educate us!
1/ IVC
2/ 👆Consistent with elevated right atrial pressure.
👇Hepatic vein #VExUS
D-only pattern (rhythm: ventricular paced)
👇Hepatic vein #VExUS
D-only pattern (rhythm: ventricular paced)
1/ I find the over reliance on the Adrogue-Madias (AM) formula to predict SNa changes after infusion of a specific IV fluid astounding. #hyponatremia tweetorial
2/ First of all, AM and other formulas (eg. Free Water Deficit formula) are simple mathematical manipulations of the simplified Edelman equation
3/ A study showed that the AM formula underestimated the true rate of correction in up to 75% of patients with severe hyponatremia when given 3% saline. In many of them, by a factor of 5. pubmed.ncbi.nlm.nih.gov/17913972/
Record #heat. Tough weekend in the #PNW. Seattle=City with #1 lowest AC. For sure - heat-related illness and deaths to happen. what to do? I share a #tweetorial about lessons learned from @FortBenning -when I was CMO of the hospital there.
Please retweet if useful. #medtwitter
Please retweet if useful. #medtwitter
In Georgia, our medical team had to tackle issues of heat illnesses - from heat exhaustion, heat strokes and exercise associated hyponatremia (#EAH) - and tragically the deaths too. We re-learned lessons lost from the past and learned new ones.
Lesson 1: Young, healthy, and fit people die in the heat.
There's no age discriminator for heat stroke. Heat that cannot be dissipated will kill anyone eventually. Heat comes from mainly two sources - the environment and the person; especially if exerting oneself.
There's no age discriminator for heat stroke. Heat that cannot be dissipated will kill anyone eventually. Heat comes from mainly two sources - the environment and the person; especially if exerting oneself.
1/How can #POCUS #echofirst help in the evaluation of #hyponatremia?
#Nephrology consulted for low sodium. Pt received diuretic for shortness of breath (which was possibly due to hiatal hernia as shown on CXR).
2 physicians FELT patient was EUVOLEMIC
Small 🧵below 👇 #MedEd
#Nephrology consulted for low sodium. Pt received diuretic for shortness of breath (which was possibly due to hiatal hernia as shown on CXR).
2 physicians FELT patient was EUVOLEMIC
Small 🧵below 👇 #MedEd
2/Based on the above labs, it does look like euvolemic hyponatremia (Urine Na is high, Uosm >100 but not too high, BUN not high). BP was 150s systolic.
That's it? Give some salt tablets or UreNa etc.?
No; perform PHYSICAL EXAM (= #POCUS)
IVC was small - doesn't tell much 😬
That's it? Give some salt tablets or UreNa etc.?
No; perform PHYSICAL EXAM (= #POCUS)
IVC was small - doesn't tell much 😬
3/ Next step? Look at the heart, assess stoke volume.
Recent echo LVEF>50%
LV contraction looks good visually
We measured LVOT VTI (couldn't measure LVOT diameter due to chest deformity precluding good PLAX view but its not a problem; VTI is generally enough)
#POCUS
Recent echo LVEF>50%
LV contraction looks good visually
We measured LVOT VTI (couldn't measure LVOT diameter due to chest deformity precluding good PLAX view but its not a problem; VTI is generally enough)
#POCUS
1/ This is like the Bat Signal for me... #Tweetorial #Hyponatremia #LoudlyForThePeopleAtTheBackOfTheRoom
2/ The first question in hyponatremia is...
👏Is👏the👏patient👏seizing?👏
If you have a patient with cerebral edema from acute hyponatremia you need to 3% Saline first and ask questions later.
👏Is👏the👏patient👏seizing?👏
If you have a patient with cerebral edema from acute hyponatremia you need to 3% Saline first and ask questions later.
3/ If patients have hyponatremia and have severe symptoms it is 150 ml of 3% then recheck the sodium and give another 150 ml of 3% (I'm using the European guidelines) eje.bioscientifica.com/view/journals/…
1a/14
It’s 1:34 p.m. and the ED pages you for hyponatremia. 📟
A 45 y/o M with no known medical history presents after a seizure with a sodium of 102 mEq/L.
#tweetorial #MedTwitter #Nephtwitter #hyponatremia @theskeletonkeygroup
What's your first move?
It’s 1:34 p.m. and the ED pages you for hyponatremia. 📟
A 45 y/o M with no known medical history presents after a seizure with a sodium of 102 mEq/L.
#tweetorial #MedTwitter #Nephtwitter #hyponatremia @theskeletonkeygroup
What's your first move?
1b/14
The initial evaluation of hyponatremia must “evaluate osmolality excluding hyperglycemia and other causes of non-hypotonic (SOsm >275) hyponatremia.” - per the European Guidelines (PMID: 24569125) 🇪🇺🇪🇺🇪🇺
We find a hyperosmolar hyponatremia:
The initial evaluation of hyponatremia must “evaluate osmolality excluding hyperglycemia and other causes of non-hypotonic (SOsm >275) hyponatremia.” - per the European Guidelines (PMID: 24569125) 🇪🇺🇪🇺🇪🇺
We find a hyperosmolar hyponatremia:
2a/14
What is the most likely cause of hyponatremia?
What is the most likely cause of hyponatremia?
1/ The answer to our last poll: cisplatin
nephsim.com/case-13-diagno…
Below, a brief #tweetorial to walk through a simplified approach to #hyponatremia
Step 1: What type of hypoNa are we dealing with here?
Ex: Na 128 meq/L, glucose 500 mg/dL, BUN 20 mg/dL serum osm 292 mosm/kg
nephsim.com/case-13-diagno…
Below, a brief #tweetorial to walk through a simplified approach to #hyponatremia
Step 1: What type of hypoNa are we dealing with here?
Ex: Na 128 meq/L, glucose 500 mg/dL, BUN 20 mg/dL serum osm 292 mosm/kg
2/
Remember the difference between tonicity (a measure of EFFECTIVE osmoles) & osmolality (measure of both EFFECTiVE & INEFFECTIVE osmoles)
Effective osmoles cannot cross between the ECF and ICF, thus draw water across the cell membrane.
nephsim.com/image-gallery/
Remember the difference between tonicity (a measure of EFFECTIVE osmoles) & osmolality (measure of both EFFECTiVE & INEFFECTIVE osmoles)
Effective osmoles cannot cross between the ECF and ICF, thus draw water across the cell membrane.
nephsim.com/image-gallery/
3/
If serum osm not low with hypoNa, we must look for the presence of ⬆️effective & ineffective osmoles (that ⬆️osmolality)
-If we find⬆️ effective osmoles ➡️ HYPERtonic hypoNa
-If we find ⬆️ INeffective osmoles ➡️ HYPOtonic hypoNa
-If neither ➡️ PseudohypoNa
If serum osm not low with hypoNa, we must look for the presence of ⬆️effective & ineffective osmoles (that ⬆️osmolality)
-If we find⬆️ effective osmoles ➡️ HYPERtonic hypoNa
-If we find ⬆️ INeffective osmoles ➡️ HYPOtonic hypoNa
-If neither ➡️ PseudohypoNa
Time for another #tweetorial on fluid restriction in #hyponatremia from SIADH. Is there a way to predict which patients with SIADH will respond to fluid restriction?
1/It has been said that the first line therapy for SIADH is fluid restriction but 60-70% of patients with SIADH will not respond to fluid restriction alone and they require the addition of a drug (e.g., urea). How can we tell who will respond and who won’t?
2/We can predict responsiveness to fluid restriction by using the concept of electrolyte-free water clearance.
