Podcast 178 – A Better Management Strategy for Symptomatic Hyponatremia (dDAVP Clamp) - a podcast by Scott D. Weingart, MD FCCM
from 2016-07-25T20:47:45
I laid out my thoughts on the management of hyponatremia way back in Podcast 39. Josh has weighed in here on the dDAVP clamp as well. I'd been continuing my readings on this matter, especially with some great posts from the renal fellow network (below). Then, fortuitously, I was approached by Nand Wadhwa, one of our amazing nephrologists at Stony Brook. He wanted to partner with my unit to create a euvolemic hyponatremia protocol. So in this episode, we'll discuss the use and basis of the new Euvolemic Hyponatremia Guideline.
The Protocol
Included Patients
* Euvolemic or Hypovolemic
* Na <=125 (we changed this to <=120)
Evidence for dDAVP Clamp with 3%
* Am J Kidney Dis. 2013;61(4):571-578
* Clin J Am Soc Nephrol 9: 229–237, 2014
from this post
http://renalfellow.blogspot.com/2014/10/severe-chronic-hyponatremia_20.html
Clin J Am Soc Nephrol 2007;2:1110
Modified Edelman Equation
from Androgue, Madias 2012
Video on Why Androgue Madias Equation doesn't work and how to use the Edelman Equation from Hashim Mohmod
Causes of Hyponatremia
See this Deranged Physiology Page and the LitFL Page
The Renal Fellow Network Hyponatremia Series by Hashim Mohmand
* Part 1
* Part 2
* Part 3
* Part 4
* Part 5
Key Points from the Series
Severe hyponatremia is multifactorial
Sood et al.
Three issues that will screw your plans up:
* Subclinical Volume Depletion: Because we suck at assessing this
* Solute Depletion Hyponatremia: For instance, "Tea and Toast Diet " hyponatremia and "Beer Potomania."
* Hypokalemia Repletion [case report]
* Read a Review Article by Dr. Mohmand on these issues
Review Articles
* Crit Care Hyponatremia Review 2013
* Androgue Madias Review
Peripheral 3% Hypertonic Saline is Safe
* Here is just some of the evidence
Things to think About
Further episodes of EMCrit Podcast
Further podcasts by Scott D. Weingart, MD FCCM
Website of Scott D. Weingart, MD FCCM