Put on your thinking caps for this week's #PhysioQuizzo!
After finishing ID consults two weeks ago, you find yourself on renal consults. Your attending gives you two new consults:
1) 30yoM, serum Na 121, SOsm 252
2) 30yoM, serum Na 120, SOsm 253
(Questions on the next page!!!)
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#PhysioQuizzo Patient #1: Na 121, SOsm 252, asymptomatic. The attending tells you his urine Osm is 70. She asks you how you want to cure the patient's hypoNa. You say that, before you decide, you want to know more about the patient's... [You only get 1 choice]3 replies 1 retweet 3 likesShow this thread -
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#PhysioQuizzo Patient #2: Na 120, SOsm 253, asymptomatic. Yesterday, Patient #2 got 1L of normal saline. His SNa yesterday was 119. Urine studies today: UOsm 506, UNa 170, UK 54. The primary team wants guidance on how much normal saline to give and how fast. You say...2 replies 2 retweets 6 likesShow this thread -
We'll post answers in 2 days when the polls end!!!
@PittIMChiefs@PittIMPD@PittIMPOCUS@OHSUIMRes@thecurbsiders@OHSUIMRes@UTSWIMchief@JMAllenbaugh@TempleIM@kidney_boy@NephroMD@IMCreighton@BostonChiefs@BrighamChiefs@BMCimRES@mgsimonson1@MFleshner301@akohlimd2 replies 1 retweet 2 likesShow this thread -
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#PhysioQuizzo Great work everyone! Here are the solutions. 1) Patient #1: You want the HISTORY. UOsm < SOsm, so this patient has an ADH *independent* cause of hyponatremia (ADH is low, urine is relatively dilute)! But what does that mean?1 reply 0 retweets 0 likesShow this thread -
5/x Patient 1 solution With dilute urine / low ADH, your Ddx is narrowed down to - poor solute intake (beer potomania, tea and toast diet) -excessive water intake (1* polydipsia) A good patient history will help you decide which of these three is the culprit!
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6/x Patient #1 solution. A note about "Volume Status" and hyponatremia. --> It is unreliable and therefore unhelpful. See this study: https://www.ncbi.nlm.nih.gov/pubmed/3674097 Physicians inconsistently distinguish hypovolemia from euvolemia by exam alone (correct ~47-48%). That's a coin flip!
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#PhysioQuizzo Speaking of Volume Status and hypovolemia, nephrologist extraordinaire@NephroMD taught us a different schema for thinking about hyponatremia. We'll post our version here (what we remember) , and ask for corrections from@NephroMD and the rest of@askrenalpic.twitter.com/uzZ7rUjsMd
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Agree with the pathophysiologic approach of
#hyponatremia. Not the "classic" Volume based approach. This is our hyponatremia schema approach.@Saltwebsite@grepmeded http://www.medigraphic.com/pdfs/revmed/md-2014/md142i.pdf …pic.twitter.com/U0DKvRGaBv
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Replying to @aldorodrigo @MedEdPGH and
The only issue is that Uosm > 100 not always means presence of ADH.
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are there particular conditions where this is not true or is it just not reliable?
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Replying to @grepmeded @aldorodrigo and
No, so that is why is better to compare Uosm and Posm. Appropriate response to hypotonicity is to produce a diluted urine (Uosm < Posm), if Uosm>Posm then this is an inappropriate response, then vasopressin must be present.
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