1 / 7

Case 2: Different Causes of Hyponatremia

Case 2: Different Causes of Hyponatremia. Dilutional hyponatremia. True hyponatremia. Iso-osmotic. PseudohypoNa. Case 2: Different Causes of Hyponatremia. Hyponatremia 1. Calculated osmolality = 2 x Na + GLU/18 + BUN/2.8 2. measured osmolality 3. Osmolar gap = measure osm – calculated osm

manton
Télécharger la présentation

Case 2: Different Causes of Hyponatremia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case 2: Different Causes of Hyponatremia

  2. Dilutional hyponatremia True hyponatremia Iso-osmotic PseudohypoNa

  3. Case 2: Different Causes of Hyponatremia

  4. Hyponatremia 1. Calculated osmolality = 2 x Na + GLU/18 + BUN/2.8 2. measured osmolality 3. Osmolar gap = measure osm – calculated osm Increased osmolar gap >10 • Ethanol, methanol, ethylene glycol, mannitol • Pseudohyponatremia ( hyperproteinemia , hyperlipidemia )

  5. Case 1 • True and acute hyponatremia with brain edema, not a chronic ,注意治療要快一點 • Case 2 • Iso-osmotic or pseudohyponatremia due to hyperproteinemia, hyperlipidemia • Nonsense osmolar gap, 間接性的關係 • 不用治療

  6. Case 3. • Hyperosmotic hyponatremia due to hyperglycemia • 先算 Na decrease 1.6 meq/L for each increase glucose100mg/dl • mOsm increases in parellel with cosm, osm gap is zero • Effective osm is abnormally increased, 要先 r/o risk of brain edema • Treat hyperglycemia • Case 4 • Hyperosmotic hyponatremia due to mannitol • Mannitol is non sodium particle • Cosm 裏面 mannitol 沒有算進去 , abnormal low value of Cosm and increased osm gap • 有無 brain edema 要看 effective osm, not sodium • cerebral edema 用 mannitol 治療後 Brain cell volume 變 relatively 小

  7. Case 5 • True hyponatremia due to elevated BUN , renal insufficiency • Mosm and Cosm 裏面 BUN算進去. The OG is Zero • Urea is ineffective osmole • Effective osm is low, hyponatremia 是有意義的, 有 risk of cerebral edema, • Treatment 快 or慢 depend on condition Case 6 • True hyponatremia, due to use of glycine in TURP or bladder irrigation , methanol, ethanol ingestion,  retained particle, 有 osm gap • Low effective osmolality is increased risk of cerebral edema • Treatment is urgent

More Related