#48: Hyponatremia Deconstructed
Published July 17, 2017
88 min
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    Step up your salt game. We deconstruct hyponatremia with expert tips from our Chief of Nephrology, Dr. Joel Topf aka @kidney_boy aka The Salt Whisperer. Topics include: true versus false hyponatremia, SIADH, tea and toast/beer potomania, safe rates of sodium correction, fluid restriction, salt tablets, IV fluid choice, DDAVP clamps, and more.

    Full show notes available at http://thecurbsiders.com/podcast

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    Case: 85yo F with anxiety, asthma, HTN (on a CCB), hypothyroidism with TSH of 3 on therapy. Sodium was 128 from previous values 134-137 mg/dL. She is more fatigued than usual.

    Time Stamps

    00:00 Intro

    03:00 Guest interview

    06:45 Pick of the week w/Dr. Topf

    15:50 Clinical case of hyponatremia

    17:18 False hyponatremia normal osmolality

    19:04 False hyponatremia high osmolality

    20:06 Understanding why osmolality matters

    22:58 Workup false hyponatremia

    24:15 Recap of discussion so far

    25:10 ADH dependent vs independent hyponatremia

    26:30 Psychogenic polydipsia

    28:45 Renal failure and hyponatremia

    29:33 Tea and toast, and Beer Drinker’s potomania

    34:42 ADH dependent hyponatremia

    37:45 Volume versus osmolality

    39:30 Volume status exam

    44:44 Additional testing with urine lytes and uric acid

    47:00 Treatment for SIADH

    52:12 Discussion of the vaptans

    57:51 Additional testing in SIADH

    62:20 When to admit patient for hyponatremia

    63:29 Clinical case of hyponatremia complications

    68:26 Fluids and rate of correction

    73:06 DDAVP clamp

    76:00 Moderate hyponatremia

    78:05 Diuretic dosing DOES matter!

    81:29 Loop diuretics for SIADH

    83:55 Take home points

    86:55 Outro

    Tags: hyponatremia, salt, sodium, SIADH, ADH, vasopressin, fluids, electrolytes, kidney, nephrology, osmolality, urine, concentration, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

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