Treatment of Symptomatic Hyponatremia
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What is the primary goal of treating patients with symptomatic hyponatremia?

  • To achieve a normal serum sodium level
  • To monitor serum sodium every hour
  • To increase serum sodium to 120-125 mEq/L to avoid adverse neurologic outcomes (correct)
  • To rapidly correct hyponatremia as quickly as possible

    • How quickly can serum sodium be increased in patients with severe symptoms?

  • Up to 5 mEq/L/hour
  • Up to 1 mEq/L/hour
  • Up to 10 mEq/L/hour
  • Up to 2 mEq/L/hour for a short time (correct)

    • What is the recommended infusion rate of 3% hypertonic saline for severe symptoms?

  • 1-2 mL/kg/hour (correct)
  • 0.5-1 mL/kg/hour
  • 2-3 mL/kg/hour
  • 3-4 mL/kg/hour

    • What is a potential complication of rapid correction of hyponatremia?

    <p>Osmotic demyelination syndrome</p> Signup and view all the answers

    Why is hypertonic saline not recommended for chronic hyponatremia?

    <p>Because of the risk of osmotic demyelination syndrome</p> Signup and view all the answers

    What can be done to prevent hyperchloremic acidosis when administering hypertonic saline?

    <p>Administering hypertonic saline in a 1:1 or 2:1 ratio of NaCl and sodium acetate</p> Signup and view all the answers

    How often should serum sodium be monitored in patients receiving hypertonic saline?

    <p>Every 1-4 hours</p> Signup and view all the answers

    What is the maximum change in serum sodium recommended in 24 hours?

    <p>10-12 mEq/L</p> Signup and view all the answers

    What is the primary cause of symptoms in hypernatremia?

    <p>Dehydration of brain cells</p> Signup and view all the answers

    What is the primary mechanism to prevent hypernatremia?

    <p>Thirst and subsequent water intake</p> Signup and view all the answers

    What is a common cause of hypernatremia in infants?

    <p>Inability to regulate water balance</p> Signup and view all the answers

    What is the typical serum sodium level associated with hypernatremia?

    <p>Greater than 145 mEq/L</p> Signup and view all the answers

    Why do patients with chronic hypernatremia remain asymptomatic?

    <p>They have cerebral osmotic adaptation</p> Signup and view all the answers

    What is a potential complication of rapid correction of chronic hypernatremia?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of osmoregulation?

    <p>Maintain plasma osmolality between 275-290 mOsm/kg</p> Signup and view all the answers

    What is a treatment consideration for hypernatremia?

    <p>Slow correction of serum sodium</p> Signup and view all the answers

    What is a potential complication of administering a hypertonic solution to correct hyponatremia?

    <p>Hypernatremia</p> Signup and view all the answers

    Why is it important to correct hypokalemia before correcting hyponatremia?

    <p>Because hypokalemia reduces serum sodium</p> Signup and view all the answers

    What is the initial goal of treatment for the patient's hyponatremia?

    <p>Increase Na+ concentration to 126 mEq/L</p> Signup and view all the answers

    What is the potential consequence of rapid correction of serum sodium?

    <p>Central pontine myelinolysis</p> Signup and view all the answers

    What should be administered to the patient in addition to discontinuing hydrochlorothiazide?

    <p>0.9% sodium chloride infused at 100 mL/hour</p> Signup and view all the answers

    What is the effect of hypokalemia on serum sodium?

    <p>It decreases serum sodium</p> Signup and view all the answers

    What is the best recommendation for the patient one day after initial treatment?

    <p>D5 W/0.9% sodium chloride plus potassium chloride 40 mEq/L to infuse at 100 mL/hour</p> Signup and view all the answers

    Why is it important to use caution when giving potassium to correct hypokalemia?

    <p>To prevent rapid correction of serum sodium</p> Signup and view all the answers

    What is the maximum rate at which serum sodium should be reduced in patients with symptomatic hypernatremia?

    <p>0.5 mEq/L/hour</p> Signup and view all the answers

    What is the recommended approach to treat hypernatremia?

    <p>Replace water deficit slowly over several days</p> Signup and view all the answers

    What is the estimated water deficit in liters, in women, based on Lean Body Weight (LBW) and serum sodium?

    <p>(0.4 × LBW) × [(Serum sodium/140) − 1]</p> Signup and view all the answers

    What is the primary mechanism by which potassium balance is maintained between the IC and EC compartments?

    <p>Passive shifts based on the concentration gradient across the cell membrane</p> Signup and view all the answers

    What is the normal plasma potassium concentration range?

    <p>3.5-5 mEq/L</p> Signup and view all the answers

    What is the primary cause of hypokalemia?

    <p>Increased renal excretion of potassium</p> Signup and view all the answers

    What is the purpose of administering D5W in the treatment of hypernatremia?

    <p>To replace water deficit slowly</p> Signup and view all the answers

    What is the recommended treatment for a patient with concurrent Na+ and water depletion?

    <p>A combination of D5W and 0.225% sodium chloride</p> Signup and view all the answers

    What level of plasma potassium typically causes muscle weakness or paralysis?

    <p>Above 8 mEq/L</p> Signup and view all the answers

    What may occur if K+ is released from blood cells while or after obtaining the blood specimen?

    <p>Pseudohyperkalemia</p> Signup and view all the answers

    What is the treatment for asymptomatic hyperkalemia patients?

    <p>Cation exchange resin alone</p> Signup and view all the answers

    What is the indication for urgent and immediate treatment of hyperkalemia?

    <p>All of the above</p> Signup and view all the answers

    Why is calcium administered intravenously to patients with symptomatic hyperkalemia?

    <p>To prevent hyperkalemia-induced arrhythmias</p> Signup and view all the answers

    What is the preferred form of calcium administered peripherally for hyperkalemia?

    <p>Calcium gluconate</p> Signup and view all the answers

    What is the duration of action of calcium gluconate in treating hyperkalemia?

    <p>30-60 minutes</p> Signup and view all the answers

    What is the purpose of administering calcium gluconate in hyperkalemia?

    <p>To antagonize the effect of K+ in cardiac conduction cells</p> Signup and view all the answers

    Study Notes

    Treatment of Symptomatic Hyponatremia

    • Goal is to achieve a safe serum sodium concentration (120-125 mEq/L) to avoid adverse neurologic outcomes in symptomatic patients.
    • Increase serum sodium by 0.75-1 mEq/L/hour to a concentration of 120 mEq/L, but not more than 10-12 mEq/L in 24 hours.
    • In severe symptoms, serum sodium can be increased by up to 2 mEq/L/hour for a short time, as long as the maximum change of 10-12 mEq/L in 24 hours is not exceeded.
    • Infusion rate of 3% hypertonic saline is generally 1-2 mL/kg/hour for severe symptoms.

    Complications of Hypertonic Saline

    • Osmotic demyelination syndrome (includes central myelinolysis) can occur with rapid correction of hyponatremia.
    • Hypokalemia can occur with large volumes of hypertonic saline.
    • Hyperchloremic acidosis can result from the administration of chloride salts.
    • Hypernatremia can occur due to fluid overload from initial volume expansion.
    • Phlebitis if administered in a peripheral vein.
    • Coagulopathy caused by platelet dysfunction.

    Correcting Hypokalemia

    • Hypokalemia will cause a reduction in serum sodium because Na+ enters cells to account for the reduction in IC K+ to maintain cellular electroneutrality.
    • Administration of K+ will help correct hyponatremia.
    • Use caution when giving K+ to prevent rapid correction of serum sodium.

    Hypernatremia and Hyperosmolar States

    • Hyperosmolality with serum sodium greater than 145 mEq/L.
    • The osmotic gradient associated with hypernatremia causes water movement out of cells and into the EC space.
    • Symptoms are related primarily to the dehydration of brain cells.

    Causes of Hypernatremia

    • Loss of water because of fever, burns, infection, renal loss (e.g., diabetes insipidus), gastrointestinal (GI) loss.
    • Retention of Na+ because of the administration of hypertonic saline or any form of Na+.
    • Certain neurologic injuries receive hypertonic saline to target a higher sodium goal.

    Prevention of Hypernatremia

    • Plasma osmolality is maintained at 275-290 mOsm/kg, despite changes in water and Na+ intake.
    • Hypernatremia is prevented first by the release of ADH, causing water reabsorption.
    • Hypernatremia is also prevented by thirst.

    Symptoms of Hypernatremia

    • Lethargy, weakness, and irritability.
    • Twitching, seizures, coma, and death if serum sodium is greater than 158 mEq/L.
    • Cerebral dehydration can cause cerebral vein rupture with subsequent intracerebral or subarachnoid hemorrhage.

    Treatment of Hypernatremia

    • Rapid correction of chronic hypernatremia can result in cerebral edema, seizure, permanent neurologic damage, and death.
    • Serum sodium should be reduced slowly by no more than 0.5 mEq/L/hour or 12 mEq/L/day.
    • Treat hypernatremia by replacing water deficit slowly over several days to prevent overly rapid correction of serum sodium.

    Disorders of K+

    • Normal plasma potassium concentrations are 3.5-5 mEq/L.
    • K+ balance is maintained between the IC and EC compartments by several factors, including β2-adrenergic stimulation and insulin.
    • Plasma potassium concentration directly correlates with movement of K+ in and out of cells because of passive shifts based on the concentration gradient across the cell membrane.

    Hypokalemia

    • Causes of hypokalemia include reduced intake, renal loss, gastrointestinal loss, diuretic-induced depletion, and increased IC shift.
    • Muscle weakness or paralysis is caused by changes in neuromuscular conduction; it typically occurs when plasma potassium exceeds 8 mEq/L.

    Treatment of Hyperkalemia

    • Patients with asymptomatic hyperkalemia can be treated with a cation exchange resin (e.g., sodium polystyrene sulfonate) alone.
    • Urgent and immediate treatment is required for patients with severe muscle weakness, ECG changes, or plasma potassium greater than 6.5 mEq/L.
    • Calcium gluconate can be administered intravenously to patients with symptomatic hyperkalemia to prevent hyperkalemia-induced arrhythmias, even if patients demonstrate normocalcemia.

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    Learn about the treatment goals and guidelines for patients with symptomatic hyponatremia, including the rate of serum sodium increase and target concentrations.

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