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2017年2月16日 星期四

實戰課題Medical internship topic 6: Hyponatremia

Hyponatremia
1.      Def: <135mmol/L
2.      First DDx: rule out pseudo-hyponatremia
  • Hypertonic: hyperglycemia?

Nahyperglycemia時會降低,correct Na=Na + 1.4×(sugar100)
  • Isotonic : hyperlipidemia, hyperproteinemia?
  • Another consideration: sample mixed with IV injection fluids?

3.      Hypotonic :
  • Too much water? (beware of fluid retention)à do not give N/S, but restrict Na+ and water intake
  • Not enough solutes? (beware of poor intake)à may give N/S

4.      Symptoms:
nausea and vomiting, headache, confusion, loss of energy and fatigue,
restlessness and irritability, muscle weakness, spasms or cramps, seizures, coma

5. Na supplement if needed
  •  Rate of infusion is important
  •  應補鈉總量(mmol=[135-病人血Na+(mmol/L)]×體重(kg)×0.6~0.5
  •  補鈉的速度不能超過4~6 mEq/L/hour24 hrs內不能超過9 Eq/L

6. Monitoring
  •   Urine output
  •   Na recheck Q4H



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