RENAL AND ELECTROLYTE
HYPONATRAEMIA
PromptInvestigations for hyponatraemia
ResponseGLUCOSE
Plasma osmolality - determine if pseudohyponatramia or real. Should be hypoosmolar if real
Urine Sodium
Urine osmolality
Previous/recent plasma sodium (?acute vs chronic)
TFT’s
Cortisol level
Plasma osmolality - determine if pseudohyponatramia or real. Should be hypoosmolar if real
Urine Sodium
Urine osmolality
Previous/recent plasma sodium (?acute vs chronic)
TFT’s
Cortisol level
PromptLabs to differentiate cause of hyponatraemia
ResponseHypovolaemic - Urine sodium
High urine sodium - Diuretics, mineralocorticoid deficiency, sodium losing nephropathy (ie: Kidneys fucked and excreting sodium when they shouldn’t be)
Low urine sodium - GI losses, skin losses, 3rd space losses (Pancreatitis, peritonitis) - ie: sodium lost outside of kidneys
Euvolaemic - Urine osmolality
Low urine osmolality - Hyperlipidaemia, hyperproteinemia, hyperglycaemia
High urine osmolality - SIADH, Psychogenic polydipsia, severe hypothyroid, drugs, glucocorticoid deficiency
Hyervolaemia - Urine Sodium
High urine sodium - (ie: kidneys fucked and losing sodium) Acute oliguric renal failure, chronic renal failure
Low urine sodium - nephrotic syndrome, CCF, Liver failure
Monash 2020.2-9 for further reading. This question sucks
High urine sodium - Diuretics, mineralocorticoid deficiency, sodium losing nephropathy (ie: Kidneys fucked and excreting sodium when they shouldn’t be)
Low urine sodium - GI losses, skin losses, 3rd space losses (Pancreatitis, peritonitis) - ie: sodium lost outside of kidneys
Euvolaemic - Urine osmolality
Low urine osmolality - Hyperlipidaemia, hyperproteinemia, hyperglycaemia
High urine osmolality - SIADH, Psychogenic polydipsia, severe hypothyroid, drugs, glucocorticoid deficiency
Hyervolaemia - Urine Sodium
High urine sodium - (ie: kidneys fucked and losing sodium) Acute oliguric renal failure, chronic renal failure
Low urine sodium - nephrotic syndrome, CCF, Liver failure
Monash 2020.2-9 for further reading. This question sucks
PromptManagement of seizure in hyponatraemia
ResponseHypertonic 3% saline
100 mL IV over 10 minutes and repeat as needed up to 3 infusions (or 1-2 mL/kg over 1 hour)
Endpoint termination of seizure
100 mL IV over 10 minutes and repeat as needed up to 3 infusions (or 1-2 mL/kg over 1 hour)
Endpoint termination of seizure
PromptTargets for correction
ResponseSodium >125
Rate of correction not more than 10mmol/day (0.5mmol/hr)
Rate of correction not more than 10mmol/day (0.5mmol/hr)