MEDI7212 Lecture Notes - Lecture 17: Water Intoxication, Ammonium Chloride, Carbamazepine
Document Summary
Sodium (na) is the most abundant cation in the extravascular & intravascular spaces: hypernatremia - serum na > 150mmol/l. Insensible loss (excess sweating in hot climate, febrile illness, extensive burns: high na intake (na gain > water gain, primary hyperaldosteronism (conn syndrome) or cushing syndrome. Iatrogenic (eg administration of 8. 4% nahco3 or hypertonic saline) Management assess severity: observe clinical manifestations, especially seizures, serum na, serum osmolality. & ecf volume: most patients usually have few symptoms and no immediate risk of death, despite having compromised organ perfusion from extracellular volume deficit, correct volume & water deficits. Lab analysis technique: hyponatremia + normal serum osmolality, hyperlipidemia, hyperproteinemia, hyponatremia + increased serum osmolality, hyperglycemia, mannitol, excess urea, toxic alcohol (ethanol, methanol, isopropyl alcohol, ethylene glycol, hyponatremia with high urinary na (>20mmol/l) Silent disease: above 125mmol/l - rarely symptomatic, below 120mmol/l - confusion, forgetful, below 110mmol/l - fits, loc, possible death, progressi(cid:448)e sig(cid:374)s a(cid:374)d sy(cid:373)pto(cid:373)s i(cid:374)(cid:272)lude . Lethargy, weakness, ataxia: nausea, vomiting, headache, confusion.
