Approach to hyponatremia authorstream presentation. Ok, i know ive covered a lot of information over the past few weeks regarding hyponatremia. Online calculator access and desktoppda freeware downloads. Sterns department of medicine, university of cincinnati medical center, cincinnati, ohio. Hyponatremia causes, algorithm, correction and treatment. Adjusted aniongap calculator, corrected for albumin. Pseudohyponatremia definition of pseudohyponatremia at. All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice.
Toorapid correction of hyponatremia risks neurologic complications, such as osmotic demyelination syndrome. Pseudohyponatremia of multiple myeloma is true hyponatremia. It is the dedication of healthcare workers that will lead us through this crisis. Hyponatremia is defined as any serum sodium hyponatremia.
It can be associated with pseudohyponatremia, or with isotonic infusion of glucose or mannitol. Fever increases insensible water losses by 10% per degree celsius above 38, or 100150 ccday increase per degree celsius above 37. Pseudohyponatremia is a term that reflects the analytical artifact for measuring sodium level and should be corrected by a formula that reflects the actual level in order to help clinicians. Hyponatremia endocrine and metabolic disorders merck. Department of medicine, university of pittsburgh medical center, pittsburgh, pennsylvania. The number of hospitalizations due to hyponatremia increased in 2010. Often referred to as pseudo hyponatremia because the elevated lipids or proteins interfere with the laboratory sodium reading.
Having said that, the fact this is stated as dilutional makes rationale to code rather weak, in my view, even w the statement it was followed with further testing. Use of vaptans in hyponatremia euvolemic and hypervolemic hyponatremia chronic symptomatic hyponatremia where underlying cause can not be corrected and long term treatment is required can be started once serum sodium 120 meql for initiating vaptan patient should be admitted for 34 days, i. To avoid central pontine myelinolysis, sodium should not be corrected faster than 0. See diagnostic evaluation of adults with hyponatremia. Medcalc download page offers medcalc new installations, program updates, medcalc file viewer and medcalc manual. The term pseudohyponatremia is often erroneously used for hyponatremia caused by hyperglycemia, which increases the blood osmolality what results in the movement of water from the cells into the blood and therefore in dilutional hyponatremia, which is true hypertonic hypervolemic hyponatremia.
As a result of the saline treatment serum sodium increased to 116 mmoll at 7 hours after admission but there was clinical evidence right hemiplegia and tonic convulsions of evolving brain. Otherwise you may be explaining pseudohyponatremia to a concerned physician. Sglt tools allows you to find and download slides decks related to sglt2 inhibitors customized for the information you researching. Defined as an osmolarity download here free healthcaremagic app to ask a doctor. Factitious hyponatremia this is due to excess increases of triglyceride in the blood, hyperglycemia, and immunoglobulin elevation in multiple myeloma. Pseudohyponatremia is defined as a spuriously low plasma sodium concentration. The rules of 6s and 100s can be used to avoid over correction.
The calcium correction for hypoalbuminemia calculates a corrected calcium level for patients with hypoalbuminemia. Please make sure you have the correct values for the microscopy parameters necessary for calculating the nyquist. Patti jones phd, dabcc, facb, is the clinical director of the chemistry and metabolic disease laboratories at childrens medical center in dallas, tx and a professor of pathology at university of texas southwestern medical center in dallas. This can be calculated manually or via several online calculators, such as medcalc. The related condition pseudonormonatremia is diagnosed if the measured sodium concentration is normal but the true plasma sodium concentration is raised.
Even with severe hyponatremia, serum sodium concentration should not be increased by more than 8 meql 8 mmoll over the first 24 hours. Since pseudohyponatremia was not recognized, the apparent hyponatremia was treated inappropriately with 0. Just enter the amount desired either at calibration or at use time. The causes of hyponatremia without hypotonicity are.
Pseudohyponatremia definition of pseudohyponatremia by. The amount and speed at which sodium is corrected must be determined before initiating replacement therapy. However, the sodium concentration will be measured as normal by direct sodiumselective electrodes used by blood gas analyzers and some pointofcare devices. Isotonic hyponatremia is a form of hyponatremia with mosm measured between 280 and 295. Causes of hyponatremia without hypotonicity including pseudohyponatremia. The evaluation of adults with hypotonic hyponatremia, the most common presentation of hyponatremia, is discussed elsewhere. Therefore, we used the correction factor of katz, 17 whereby the serum sodium level decreases by 1. The code is valid for the year 2020 for the submission of hipaacovered transactions. Adrenal insufficiency and hypothyroidism both cortisol and thyroid hormone are required for the excretion of free water. Microscopy nyquist rate and psf calculator scientific volume. Hyponatremia correction calculation in hyperglycemia. Kiechle, md, phdt pseudohyponatremia should be distinguished from true hyponatremia lest injudicious therapy be instituted.
High concentrations of intravascular protein as in multiple myeloma or lipid dilute the plasma sodium concentration, but do not alter the solute concentrations of the intracellular or interstitial fluid compartments. Pseudohyponatremia definition at, a free online dictionary with pronunciation, synonyms and translation. Make use of our decay calculator to reckon the radioactivity of an isotope. Hyponatremia can be life threatening and requires prompt recognition and proper treatment. Hyperglycemia causes osmotic shifts of water from the intracellular to the extracellular space, causing a relative dilutional hyponatremia. The treatment of hypernatremia involves correcting the underlying cause. Types of hyponatremia hypovolumic hyoponatremialowtotal body h20, decreased total body na hypovolumiamost common minerlocortoid deficiency diuretics hypervolumic hyponatremia increased total body h20,total body na normalincrease but can have decrease ecv renal failure. Only two flame photometry and indirect potentiometry of the three current methods available for measuring serum sodium involve sample dilution and may consequently produce spuriously low sodium values. Pseudohyponatremia is an exaggeration of the physiologic dilution of plasma sodium by nonaqueous material2.
Pseudohyponatremia is caused by a displacement of serum water by elevated concentrations of serum lipids or proteins. Hyponatremia international emergency medicine education. Emergency correction with a 2 mlkg body weight bolus of 3. Decay calculator cyclotron radiopharmaceuticals and radionuclides. Medical calculator for ios iphone, ipod touch, ipad. The authors make no claims of the accuracy of the information contained herein.
It occurs when hyperlipemia increases the serum nonwater volume or hyperproteinemia increases the serum nonsodium solute. Robert hodges recently provided an excellent article speaking to the clinical significance of various levels of hyponatremia. The reported frequency of hyponatremia before and after correction of sodium concentration was reduced by 42. Well, folks, i hate to say that i was right, but i was right. The causes of hyponatremia without hypotonicity are presented in this topic. Dehydration with hypernatremia or hyponatremia coding clinic, first quarter icd10 2014 page. It is an ongoing epidemic, and one that needs to be addressed. Calculates the adjusted serum aniongap, corrected for the influence of coexisting.
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