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hyponatremia

Mon, 12/03/2007 - 09:11 — oxygen
Hyponatremia Listen to Audio hyponatremia with decreased total body sodium content treatment of hyponatremia with dec total body Na content hyponatremia with normal total body sodium content treatment of hyponatremia with nl total body Na content hyponatremia with increased total body sodium content treatment of hyponatremia with inc total body sodium content calculating sodium deficit anesthetic considerations with hyponatremia Hyponatremia with decreased total body sodium content: -loss of both sodium and water ex. renal fluid loss: MCC thiazide diuretics; urinary [Na+] > 20 mEq/L ex. extrarenal loss: GI losses ; urinary [Na+] < 10 mEq/L exception: vomiting ; urinary [Na+] > 20 mEq/L Treatment of hyponatremia with decreased total body Na content: -restore fluid deficits and sodium deficits with isotonic solutions -once ECF deficit is corrected then spontaneous water diuresis returns plasma [Na+] to nl Hyponatremia with normal total body sodium content: -generally involves hyponatremia without signs of edema nor hypovolemia -urinary osmolality > 100 mOsm/kg -urine [Na+] > 40 mEq/L ex. SIADH ex. glucocorticoid insufficiency ex. hypothyroidism ex. drug therapy Treatment of hyponatremia with normal total body sodium content: -water restriction -demeclocycline (ADH analog) may help with SIADH Hyponatremia with increased total body water content: -increased total body sodium and increased total body water -increase in total body water > increase in total body sodium *progressive impairment of renal free water excretion ex. edematous disorders -congestive heart failture -cirrhosis -renal failure -nephrotic syndrome Treatment of hyponatremia with increased total body sodium content: -water restriction -loop diuretics Calculating sodium deficit Total body water (Na+ desired level – Na+ actual level) ex. 80 kg female with 50% ECF desired Na+ level: 130 mEq/L actual Na+ level: 118 mEq/L 80kg (0.5) ( 130 – 118) 40 (12) 480 mEq/L Na+ deficit normal saline = 154 mEq/L sodium therefore 480 mEq/L / 154 mEq = 3.11 L normal saline to correct sodium deficit Rate of correcting sodium deficits may be associated with degree of symptoms: -mild symptoms: 0.5 mEq/L/hr -moderate symptoms: 1.0 mEq/L/hr -severe symptoms: 1.5 mEq/L/hr ANESTHETIC CONSIDERATIONS IN HYPONATREMIA -hyponatremia often is associated with a serious underlying disorder -[Na+] > 130 mEq/L for all elective surgical procedures -hyponatremia almost always a result of urinary diluting capacity deficits -urinary osmolality < 100 mOsm/kg -may be associated with cerebral edema -decreased MAC requirements Water retention may occur with: -increase in total body water -loss of sodium > loss of water

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