Since finishing my training, I've learned three new techniques for the management of hyponatremia: the DDAVP clamp, use of hypertonic bicarbonate, and oral urea. Meanwhile, I've removed the use of vaptans from my practice and grown more comfortable using 3% saline. The confluence of these factors has transformed hyponatremia from something scary to something which is comfortably manageable. This chapter aims to present a throughly modern approach to hyponatremia, integrating the safest and most reliable therapies.
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The IBCC chapter is located here.
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Is there a reason why this issue is neither acknowledged nor fixed ? I realize that on the grand scheme of things this is a minor issue, and it doesn’t have anything to do with the quality of the content. But is there really a reason why you can’t bother with a 20 second fix that would prevent a broken link to appear on every chapter of the book ? On top of having a broken website with reduced functionality, it really doesn’t show that you value feedback / peer-review., potentially on more serious issues as well. I apologize for… Read more »
Sorry, this was a bit harder to fix than I anticipated. I think I’ve gotten it fixed now. Thanks so much for the ongoing feedback and your efforts to improve the IBCC, I really appreciate it.
Now it’s all good !!
Thanks and sorry for being a pain…
MT
Thanks so much for all the hard work you guys do, it is super helpful for a learner like me!
You say giving oral potassium will raise the sodium. Does IV potassium have the same effect? If so, what is the best way of replacing potassium in these patients?
Thanks!
Dear Josh, Mild to moderate hyponatremia is very common on the ICU. In an apparently asymptomatic patient, at what point do you correct it? You could argue that any sodium below 135 or 130 is a risk factor for delirium, and as all of our patients are at increased of delirium, we should correct the sodium. Furthermore on the ICU this can be done in a controlled manner. Equally you could argue this is a form of euboxia, in which lots of attention and phlebotomy is assigned correcting a minor lab abnormality. Thank you! Love the Book and the Podcasts… Read more »
Thanks very much for the revised approach to severe hyponatremia — I agree that the traditional algorithms never felt super helpful in practice. I was wondering how important it is to tease out acute vs chronic hyponatremia before finalizing your management plan. I understand that this is an essential consideration to help us understand the underlying physiology and anticipate potentially dire complications of hyponatremia, but I am trying to sort out how much it actually impacts management. The first decision point it seems to contribute to is whether or not to give hypertonic therapy; but, regardless of chronicity if there… Read more »
Thank you for this excellent page. Your whole website is a lifesaver for me. Question: Any pearls on the hypovolemic hyponatremic who needs volume at the same time as careful sodium correction? I had a young 40s male pt with significant etoh abuse history come in with sodium of 111, renal failure (cr 6.6, sky-high BUN, seemed hypovolemic) and pancreatitis. His BPs were 90s/60s with HR 80s but with orthostatic dizziness; I thought his pressure wasn’t critical since he had lab markers of severe cirrhosis/liver dysfunction, but his renal dysfunction with high BUN and good story for volume depletion made… Read more »
I love your take on the ddavp clamp. But every time I use it I get bad feedback from nephrology. I initiated ddavp and hypertonic on my alcoholic with beer potomania, a sodium of 111, ataxia last night and got spanked even though no overcorrection etc. I always forward them this link with all the references, but it is an uphill battle. Do you ever hear about controversies like this?