Episode 60: Emergency Management of Hyponatremia

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 3 March 2015

⏱️ 65 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this EM Cases episode Dr. Melanie Baimel and Dr. Ed Etchells discuss a simple and practical step-wise approach to the emergency management of hyponatremia: 1. Assess and treat neurologic emergencies related to hyponatremia with hypertonic saline 2. Defend the intravascular volume 3. Prevent further exacerbation of hyponatremia 4. Prevent rapid overcorrection 5. Ascertain a cause Dr. Etchells and Dr. Baimel answer questions such as: What are the indications for giving DDAVP in the emergency management of hyponatremia? What is a simple and practical approach to determining the cause of hyponatremia in the ED? How fast should we aim to correct hyponatremia? What is the best fluid for resuscitating the patient in shock who has a low serum sodium? Why is the management of the marathon runner with hyponatremia counter-intuitive? What strategies can we employ to minimize the risk of Osmotic Demyelination Syndrome (OSD) and cerebral edema in the emergency management of hyponatremia? and many more...

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases podcast.
0:05.8	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine
0:10.5	from EMC Studios in Toronto.
0:14.9	On this episode on hyponetremia, we have with us Dr. Melanie Bamell and Dr. Ed Etchels.
0:21.1	Dr. Bamel is an emergency physician at Sunnybrook Health Sciences Center in Toronto,
0:25.5	faculty in the Department of Family and Community Medicine at the University of Toronto,
0:29.4	and faculty for the Emergency Ultrasound Fellowship.
0:32.8	The risk of overcorrection trumps our impression that the patient looks a bit dry.
0:37.9	I think you just have to resist the natural urge as an emergency dog to give fluids.
0:44.2	Dr. Ed Etchols is an internist at Sunnybrook Health Sciences Center in Toronto and an associate
0:49.0	professor at the University of Toronto. He's the recipient of multiple teaching awards.
0:53.7	It's not the fluids that you're running into the bloodstream that's causing the trouble. He's the recipient of multiple teaching awards. It's not the fluids that you're
0:55.2	running into the bloodstream that's causing the trouble. It's the urine that's running out of the
0:59.2	patient's bladder that's causing the trouble. All water can kill these patients. If the urine
1:05.2	osmosis less than 100, give DDAVP. Hypoenaeotremia is rampant in our EDs.
1:12.7	It's the most common disorder of body fluid and electrolyte balance
1:16.1	encountered in clinical practice,
1:17.9	and it's found in about 20% of admissions to hospital.
1:22.0	It can present with a wide spectrum of symptoms,
1:25.0	and it's often difficult to manage.
1:27.0	Now, you might be thinking hyponitemia isn't really a diagnosis, it's often difficult to manage. Now, you might be thinking,
1:28.3	hyponotremia isn't really a diagnosis, it's just a lab value. That hyponitremia itself
	...

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