醫學筆記匯整 ED Notes

 Step 1 - Send Lots of Labs 

• Serum-electrolytes
• LFTs
• osmolality
• uric acid (if on diuretics)
• TSH and cortisol as well (if you have any suspicion of an endocrine cause)
• Urine - UA, urine lytes, urine urea, urine uric acid (if on diuretics)
  urine osm, urine creatinine

 Step II -Treat CNS dysfunction 

If the patient is altered, comatose, seizing, or has neurologic findings
then raise the sodium by a little bit

 Give 3% saline, 100 ml over 10-60 minutes 
   (2 cc/kg up to a max of 100 cc)

10 minutes later, may repeat X 1

may be given peripherally through any reasonable IV
each 100 ml will raise sodium by ~2 mmol/l

Actue 可以上升 2 ~ 3 mEq/hr  (ㄧ開始 2-3 hr) 直到 symptoms releif 
不過我看醫生為了安全都是少少給慢慢校正 ~ 

How to treat seizures caused by hypo-Na ?

 Step III - Hang tight 

Do not feel the need to do anything else, just fluid restrict the patient

 - Place a foley
 - Do not feel tempted to give NS
 - Do not be clever, just fluid restrict and admit.
 - Patients are at a fall risk with hyponatremia
 - Get a CT scan if they are still a little wacky

 - Remember the rules of 6' s (from the Stern article below)

Be incredibly careful when correcting hypokalemia, potassium repletion will raise the Na !
這句無法參透 XD 以下也都看不懂 XD
 

 Step IV - What to do when you couldn' t follow step III 

• dDAVP 1-2 mcg IV or SubQ x 1
• Consult renal
• Consider D5W 6ml/kg over 1 hour
  in consultation with renal if you have really screwed up

 Additional Info : 

Drugs - Thiazides, SSRI, Sufonylureas, Opioids

1 liter of saline will allow a solute - low hyponatremia to make 6 L of urine

• SIADH - need to get rid of a 600 mmol salt load/day. Can fluid restrict to 900 ml (400 insensible).
  SIADH 尿太濃, 給 NS 只會越給鈉越低
  不想給 3% Saline 就靠限水, 吃鹽, 吃高蛋白