By Richard Arthur Preston
Univ. of Miami, FL. Concise guide on fixing difficulties pertaining to advanced fluid, electrolyte, and acid-base issues. For scientific scholars, interns, citizens, nurses and nurse practitioners, and first-year nephrology fellows. Softcovers.
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Extra info for Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple (1st Edition)
A patient presents with polyuria and polydipsia and altered mental status. On physical examination, the patient is poorly responsive. There is poor skin turgor and a blood pressure drop from 100184 to 80162 on sitting, with a pulse increase from 92 to 128. Laboratory studies show: glucose 2100 mgldl, sodium 130 mEq/L, and blood urea nitrogen 40 mgldl. The measured osmolality is 395 mOsm/L. What is the cause of the hyponatremia in this patient, and what is the serum sodium once it has been "corrected" for the elevated glucose?
Thiazide diuretics Stop thiazides. Replace sodium (orally is usually sufficient) and potassium. Correct hypokalemia. Thiazides should not be given to any patient with hyponatremia. Increased ADH Water restriction. Find and treat underlying cause. If water excretion is severely impaired, may require NaCl tablets to add solute load or demeclocycline to antagonize ADH. Hypothyroidism Definitive therapy is to correct hypothyroidism. Adrenal insufficiency Definitive therapy is to correct adrenal failure.
SIADH What would happen if ADH secretion persisted in spite of a falling serum sodium concentration and continued water intake? Water would continue to be retained, and the serum sodium concentration would continue to decline. This is the basis for the syndrome of inappropriate ADH (SIADH), which originates in various ways (see Fig. 3-2): Abnormal increase in pituitary ADH secretion Ectopic production of tumoral ADH ADH-like effect on the collecting tubule by exogenous substances such as medications Potentiation of the renal tubular effect of ADH by drugs Any of these mechanisms may produce the same problem: hyponatremia.
Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple (1st Edition) by Richard Arthur Preston