Arielle Levitan, MD

HUNTER S PRECISION RX

9432 N MAY AVE STE A

Articles

Hyponatremia:

June 01, 2003

ABSTRACT: Correction of chronic hyponatremia is associated with a very high risk of CNS complications; avoid a rapid increase in serum sodium concentration if you suspect a patient's condition is chronic. Thiazide- or metolazone-induced hyponatremia can develop rapidly-in 1 to 2 weeks-and its only presenting signs may be fatigue and listlessness. Diuretic-induced hyponatremia is 4 times as common in women as in men. Various factors greatly increase the risk of acute hyponatremia after surgery. Hyponatremia that develops after an operation which involves irrigation with a solution of glycine, mannitol, or sorbitol (such as transurethral prostatectomy [TURP] or hysteroscopy) may be hypertonic. An osmolar gap greater than 15 is a clue to this condition. Treatment of hypertonic hyponatremia in post-TURP or posthysteroscopy syndrome may require dialysis and a nephrology consult.

Hyponatremia:

June 01, 2003

ABSTRACT: To identify the cause of hyponatremia, determine the patient's volume status and measure urinary sodium and osmolality; also ask about diuretic use. Hypovolemic hyponatremia is associated with vomiting, diarrhea, laxative abuse, renal disease, nasogastric suction, salt-wasting nephropathy, Addison disease, solute diuresis, and diuretic use. Euvolemic hyponatremia with a normal urinary sodium level can result from glucocorticoid deficiency, hypothyroidism, certain drugs, and the syndrome of inappropriate antidiuretic hormone secretion. Euvolemic hyponatremia with low urinary osmolality can be caused by psychogenic polydipsia, "tea and toast" syndrome, or beer potomania. Hypervolemic hyponatremia is associated with congestive heart failure, nephrotic syndrome, and cirrhosis. To reduce the risk of serious neurologic sequelae, avoid both undertreatment and overtreatment of hyponatremia. In chronic hyponatremia, total correction should not exceed 8 to 12 mEq/L/24 h (a maximum correction rate of 0.5 mEq/L/h). In acute hyponatremia, rates of correction up to approximately 1 mEq/L/h are acceptable. Avoid overcorrection of serum sodium concentration (ie, to a level higher than 140 to 145 mEq/L).