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The Curbsiders Internal Medicine Podcast | MedEd | FOAMed | Internist | Hospitalist | Primary Care | Family Medicine

#48: Hyponatremia Deconstructed

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#48: Hyponatremia Deconstructed

July 17th, 2017

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 Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at [email protected] 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