Oral tolvaptan is safe and effective in chronic hyponatremia [published correction appears in J Am Soc Nephrol. J Am Soc Nephrol. Dahl E, et al. Mc Causland FR, et al. Association of serum sodium with morbidity and mortality in hospitalized patients undergoing major orthopedic surgery. J Hosp Med. Leung AA, et al. Preoperative hypernatremia predicts increased perioperative morbidity and mortality. Funder JW, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an Endocrine Society clinical practice guideline.
Sands JM, et al. Nephrogenic diabetes insipidus. Ann Intern Med. Reynolds RM, et al. Disorders of sodium balance. Kahn A, et al. Controlled fall in natremia and risk of seizures in hypertonic dehydration. Intensive Care Med. This content is owned by the AAFP.
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Get Permissions. Read the Issue. Sign Up Now. Next: Evaluation and Treatment of Infertility. Mar 1, Issue. Author disclosure: No relevant financial affiliations. C 13 , 14 Consensus guidelines based on small studies Vaptans appear to be safe for the treatment of severe hypervolemic and euvolemic hyponatremia but should not be used routinely.
C 14 Consensus guidelines based on observational studies Chronic hypernatremia should be corrected at a rate of 0. Enlarge Print Evaluation of Hyponatremia Figure 1. Algorithm for the evaluation of hyponatremia Information from references 11 through Evaluation of Hyponatremia Figure 1. Enlarge Print Table 1. Table 1. Enlarge Print eTable A. Algorithm for the treatment of severe symptomatic hyponatremia. Treatment of Severe Symptomatic Hyponatremia Figure 2.
Enlarge Print eTable B. Enlarge Print Table 2. Table 2. Enlarge Print Evaluation of Hypernatremia Figure 3. Algorithm for the evaluation of hypernatremia. Evaluation of Hypernatremia Figure 3.
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Sign up for the free AFP email table of contents. Navigate this Article. Consensus guidelines based on systematic reviews. Consensus guidelines based on small studies. Consensus guidelines based on observational studies. Hyperglycemia e. Insulin, intravenous fluids, isotonic saline. Elevated total and low-density lipoprotein cholesterol levels. Hyperproteinemia e. Hypovolemic hyponatremia. Cerebral salt wasting.
Isotonic or hypertonic saline. Stop diuretic therapy. Gastrointestinal loss e. Steroid replacement therapy. Elevated glucose level, mannitol use. Correct glucose level, stop mannitol use. Renal tubular acidosis. Correct acidosis, sodium bicarbonate. Salt-wasting nephropathies. Correct underlying cause. Third spacing e.
Clinical; computed tomography. Intravenous fluids, relieve obstruction. Euvolemic hyponatremia. Beer potomania syndrome. Excessive alcohol consumption, low serum osmolality. Exercise-associated hyponatremia. Isotonic or hypertonic saline, depending on symptoms. Glucocorticoid deficiency.
Elevated thyroid-stimulating hormone level, low free thyroxine level. Thyroid replacement therapy. Increase sodium intake. Avoid use in patients with liver disease, trauma, and burns to prevent hypovolemia from worsening. Monitor closely for cerebral edema. Monitor closely for hypovolemia, hypotension, or confusion due to fluid shifting out of the intravascular space, which can be life-threatening.
Nursing, 41 5 , Intravenous fluids with a similar concentration of dissolved particles as blood plasma. Intravenous fluids with a lower concentration of dissolved particles than blood plasma. Intravenous fluids with a higher concentration of dissolved particles than blood plasma.
Proportion of dissolved particles or solutes in a specific volume of fluid. Proportion of dissolved particles in a specific weight of fluid. Previous: Next: Share This Book Share on Twitter. Fluid resuscitation for hemorrhaging, severe vomiting, diarrhea, GI suctioning losses, wound drainage, mild hyponatremia, or blood transfusions. Fluid resuscitation, GI tract fluid losses, burns, traumas, or metabolic acidosis. Am J Med. Open in Read by QxMD. Diarrhea [7] Vomiting Nasogastric tube Enteric fistula.
Febrile illness Burns Excessive sweating. Vulnerable populations e. Elderly patients Dementia No change in recent fluid intake B symptoms. Iatrogenic [6] Ingestion [8] [9]. History of lithium , aminoglycosides , amphotericin B , colchicine [10] [11] Polyuria Nocturia Polydipsia.
Hypercalcemia Hypokalemia Diluted urine , often with U osm Water deprivation test : persistent dilute urine Desmopressin challenge: U Osm does not increase. Presence of brain trauma, surgery, tumor , or infiltrative disease Polyuria Nocturia Polydipsia. U osm Water deprivation test : persistent dilute urine Desmopressin challenge: U Osm increases. Loop diuretic use [10]. Hypokalemia Hypocalcemia. Hypertension Symptoms of hypokalemia. Mild hypernatremia Hypokalemia Metabolic alkalosis.
Central obesity , moon facies, dorsocervical fat pad Hypertension. Hyperglycemia Insulin resistance Hypokalemia Metabolic acidosis Hyperlipidemia. Even though it is correct to think about fluid requirements on a hour basis, the delivery pumps used in hospitals are designed to be programmed for an hourly infusion rate.
The hour number is often divided into approximate hourly rates for convenience, leading to the "" formula. I t is clear that there is no strict daily sodium requirement since, in the normal individual, homeostatic mechanisms will instruct the kidney to conserve or excrete sodium and keep total body sodium content within the normal range. Holliday and Segar decided on this number by looking at the sodium content of human and cows' milk. Click for flashback to chemistry. When we speak about adding sodium to IV fluids, we talk about it in terms of normal saline.
Normal saline is isotonic to plasma. Note that all of these are considered hypotonic to plasma. Based on current research, it is determined that giving hypotonic solutions as maintenance IV fluids is associated with severe morbidity and even mortality due to hyponatremia.
We know that kids in the hospital are stressed. They are vomiting, or have respiratory illness, or require surgery, or have fever. All of these things cause an increase in ADH release. The more ADH, the more water is reabsorbed from the collecting duct of the kidneys. Combine this with hypotonic IV fluids, and you have a perfect formula for hyponatremia. This was estimated by Holliday and Segar to again reflect the composition of human and cow milk and has remained the same since then. In children who have a condition that might predispose to renal failure, such as dehydration, K is not added to intravenous fluids until the presence of renal function has been established.
This means that there is 0. You can apply this conversion factor to any other amount. There are two reasons for this:. Any solution that has less salt will be hypo-osmolar. Rapid infusion of a hypo-osmolar solution can cause osmotically induced water shift into the cells, and this can lead to detrimental effects such as hemolysis.
Ringer's lactate LR is a composite fluid that is available with and without dextrose. The lactate is metabolized in the liver to bicarbonate. LR provides a source of base, as well as some Ca. M aintenance fluid calculations assume that fluid loss from sensible and insensible routes is taking place at a normal rate.
But a febrile infant will be having a much greater transcutaneous evaporative water loss than one with a normal body temperature. Similarly, a child with tachypnea will lose excess water from the lungs - unless she is receiving humidified oxygen, in which case she will lose none!
Also consider patients with kidney disease who have anuria, oliguria, or polyuria. Maintenance IV fluids for these patients will not be written with the standard formula because their urinary losses are not taking place at a normal rate. Maintenance fluids using the standard formula would be too much for an anuric child with no urinary losses and too little for those with a concentrating defect in their kidneys causing polyuria. Important : Before using a standard formula for calculating maintenance fluids, ensure that the child is not having higher or lower losses than usual!
When we prescribe maintenance fluid for a 10 kg child for 24 hours as ml, we are assuming that loss from the various routes is occurring at a normal rate. However, adjustments are sometimes necessary:. What is the hour fluid requirement for a 10 kg child who has a fever of 40 degrees C.
Presuming the child is not receiving humidified O 2. What volume of maintenance fluid would you order for the next 12 hours for a 10 kg child with oliguria whose measured urine output in the previous 12 hours has been 50 ml?
I n children, the most common cause of dehydration is diarrheal fluid loss. This is known as isotonic dehydration.
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