Beruflich Dokumente
Kultur Dokumente
Homeostasis
Dr.M.Emmanuel Bhaskar
Assistant Professor in Medicine
SRMC & RI
Plan for Interaction
• Presentation of scenario-1.
• 7 Interactive questions followed by
answers for the same
• Presentation of scenario-2.
• 3 Interactive questions followed by
answers for the same
• Questioning by the delegates.
Approach to Hyponatremia…
My first question
Serum Hypo-osmolality
SIADH
Euvolemic
Adrenal Insufficiency
Hypothyroidism
Diuretic use
How to differentiate???
SIADH vs Wasting Hyponatremia
CSW/RSW is a volume contracted state
Required modification
CBG-98 mg/dl
ABG-Normal
Investigations
Hb%-16 g/dl Na-158meq/l
PCV-42 K- 4 meq/l
TC-10,000 cells Cl-106 meq/l
HCo3-26meq/l
Creatinine-1.3 meq/l
BUN-28 mg/dl CT-Brain:Normal
CSF: Normal
Comment on the Scenario
Comment on the Scenario
Symptomatic Hypernatremia
??????
Plan for Na correction
Step 1: Calculate water deficit
Patient Na-140 X Body water
140
158-140 X 30 = 4 litres
140
Plan for Na correction
Step 2: Decide on Fluid to be administered
??????????
Plan for Na correction
Step 2: Decide on Fluid to be administered
-Free water through ryles tube
-i.v 5% Dextrose
-i.v 0.45% Saline
??????????
Plan for Na correction
Step 3: Rate of correction
-0.5 meq/hour
- less than 12 meq/day
2.How to correct?
Formulae ??????
Formulae for Hypernatremia
-Formulae for determining infusate rate
may not be clinically useful.
WHY???
-Correction depends on renal handling of
administered water. This may be unique
for a given patient
A helpful protocol for correction
-Holds good if renal handling is normal
-Na<165 meq/L