When serum sodium is low or rapidly decreasing, hyponatremia may lead to cerebral edema that may result in seizures, status epilepticus, coma, or even death.
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ARF but should prompt one to test for it.
Next, follow the mnemonic C BIG K Drop.
Hemodialysis is a last resort.
Uosm should not respond to DDAVP challenge.
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Postrenal failure: Caused by urinary outflow obstructions in one or both ureters, the bladder neck, the urethra, or the prostate.
Acidosis with nephrolithiasis suggests uric acid or cystine stones.
Urine potassium levels can help determine the etiology of the hyperkalemia.
What are the next steps in diagnosis?
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GI absorption (as found in hypoparathyroidism, pseudohypoparathyroidism, vitamin D deficiency, malabsorption, renal failure, critically ill patients, and hypomagnesemia), acute pancreatitis, rhabdomyolysis, tumor lysis, and diuretics.
Intrinsic failure: Can be vascular, glomerular, tubular (most common), or interstitial.
Envision a salty desert.
Get an ECG, as this may show serious signs of hyperkalemia.
May present with fatigue, muscle weakness or cramps, ileus, hyporeflexia, paresthesias, and flaccid paralysis if severe.
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Other findings are specific to the etiology of the renal failure.
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WBCs is always abnormal except when the sample is contaminated (eg, with epithelial cells).
The man has a past medical history of smoking and CAD.
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Examination should include checking BP, daily weights, and assessment of volume status.
CHF before giving the bolus!
Euvolemic hyponatremia: If the patient is symptomatic, give hypertonic NS with furosemide.
To ensure the patient's safety, order an ECG (may show a short QT interval).
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Posm ratio to help determine the cause.
You may be able to bump hyponatremia to the bottom of your problem list, but central pontine myelinolysis will go to spot number one!
What should you do next?
Consider in patients with pancreatitis, refractory peptic ulcer disease, a personal or family history of kidney stones, or bone pain.
What do you do next?
Order a repeat blood draw unless suspicion is high.
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Patients can present in fluid overload from urinary retention.
Also consider vitamin D levels, SPEP, TSH, and imaging.
Usually indicates a nonrenal source of hypokalemia.
The pituitary does not make ADH.
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Check calcium, phosphate, albumin, ionized calcium, and alkaline phosphatase.
Identify and treat the underlying cause.
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D5W, or oral water depending on the patient's volume status.
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Start by administering calcium to stabilize the heart.
Alkalosis is most commonly associated with Proteus UTIs but may also be seen with some strains of Klebsiella, Pseudomonas, Providencia, and Staphylococcus.
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Effects of hyperkalemia as seen on ECG.
Severe or symptomatic hyperkalemia, hyperkalemia refractory to the above management, or patients on chronic hemodialysis may require acute hemodialysis.
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If the patient has a large postvoid residual, he should keep his Foley in place and be referred to urology.
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You call the laboratory, and they state that the specimen was not hemolyzed.
PTHrP secretion from cancer cells (often squamous cell carcinoma) can cause a paraneoplastic hypercalcemia.
Tx: Replace with calcium carbonate orally or with IV calcium gluconate.
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Causes include excessive hydration with hypertonic fluids, dysfunction of central regulation, and mineralocorticoid excess (consider if the patient has hypokalemia and hypertension).
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Acute interstitial nephritis yields a UA with eosinophils, WBCs, and WBC casts.
Finally, you can give Kayexalate and furosemide to dispose of the excess potassium.
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Usually indicates that the kidneys are wasting potassium.
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Often asymptomatic, but may present with confusion, lethargy, muscle cramps, and nausea.
Check plasma and urine osmolalities and sodium.
Bladder neck: Anticholinergics, tumor.
DM, is in the hospital receiving IV antibiotics for pyelonephritis.
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Note that overly rapid correction may result in central pontine myelinolysis (flaccid paralysis, dysarthria, dysphagia, and gait abnormalities).
Consider ordering a CXR.
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Do not give patients with SIADH NS, as this can paradoxically worsen the hyponatremia.
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ATN, acute interstitial nephritis, vasculitis, or anything causing renal ischemia.
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Restrict dietary potassium and discontinue any medications that may be contributing to the hyperkalemia.
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Given this patient's worsening cough, you might also consider a CXR, as this may be relevant in the setting of SIADH.
Hemorrhage Drains Skin GI.
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Evaluate the patient for urinary retention, as this is likely the cause of his renal failure.
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