You're listening to:

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

#48: Hyponatremia Deconstructed


#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 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