meta_pixel
Tapesearch Logo
Log in
The Curbsiders Internal Medicine Podcast

#48: Hyponatremia Deconstructed

The Curbsiders Internal Medicine Podcast

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.83.1K Ratings

🗓️ 17 July 2017

⏱️ 88 minutes

🧾️ Download transcript

Summary

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

Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at [email protected].

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

Transcript

Click on a timestamp to play from that location

0:00.0

You know what? I just stepped out of what I know.

0:04.4

Right? See, see if you guys were residents, I would just lie like a dog, right?

0:11.0

You're going to put this on the internet and someone's going to be like,

0:13.4

that dark doesn't know what he's talking about.

0:30.2

Welcome back to the curbsiders. Hello, Matt. Hello, Stuart. Hi. Hi. I'm at my mom's house,

0:38.0

not not recording with you from the podcast for it, which is kind of sad. Yeah. No,

0:44.0

I'm at my own house. Now I'm in my childhood podcast for it, I guess you could say,

0:49.4

at my mom's house, but soon hopefully we'll be in a in a grown-up house. Paul, are you also here?

0:57.3

Yeah. No, that's sad in any number of ways, really, just no matter how you slice it.

1:04.0

And that's Dr. Paul Williams. This is kind of a weird intro because I don't think I introduce

1:08.4

what we do on the show, which is we use expert interviews to bring you clinical pearls and

1:13.6

practice changing knowledge. I actually like this new format of just starting with

1:18.4

abusing you and then talking about the topic. I feel like this is going to break out. I like it.

1:23.2

It's more natural. The audience, the audience will probably like it. I'm sorry that Dr.

1:28.6

Toph missed this because I'm sure he would have liked this too. We just finished an extensive

1:33.9

discussion on hypo-neutremia with Dr. Joel Toph. This is a topic that I find difficult as an

1:40.6

educator, how to explain it to trainees and and also yeah, teach it to students and residents.

1:47.6

And that's why we asked him on the show. If you haven't heard our previous episode was, I believe

1:52.6

number 31. It was an episode where we talked about diuretics. Dr. Joel Toph was was our guest on

1:58.4

that one. He is a medical educator best known as at kidney underscore boy on Twitter at kidney boy.

2:06.6

He is one of the creators of the Nephrology Journal Club and Neff Madness. He's also known for his

2:12.1

blog, precious bodily fluids, musings of a salt whisperer. He wrote a an excellent test book,

...

Please login to see the full transcript.

Disclaimer: The podcast and artwork embedded on this page are from The Curbsiders Internal Medicine Podcast, and are the property of its owner and not affiliated with or endorsed by Tapesearch.

Generated transcripts are the property of The Curbsiders Internal Medicine Podcast and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.

Copyright © Tapesearch 2025.