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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