By Richard Arthur Preston
Univ. of Miami, FL. Concise guide on fixing difficulties relating advanced fluid, electrolyte, and acid-base issues. For scientific scholars, interns, citizens, nurses and nurse practitioners, and first-year nephrology fellows. Softcovers.
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Additional resources for Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple (1st Edition)
I always try to remember that mostpatients are not "standard" 70 kg men. There are many ways to write IV orders. This section offers some rough guidelines to help the beginner develop a systematic approach to writing IV orders. The following discussions assume that there are no underlying water, electrolyte, or acid-base disorders present; that there has been no recent surgery or medical illness; and that the patient has normal renal and cardiac function. Water Under normal circumstances, the daily requirement for water is about 2000-2500 cc per day.
The sodium concentration falls by about 1 mEqn for every 500 mgldl increase in triglyceride concentration. For pseudohyponatremia to develop, the degree of hypertriglyceridemia must be severe: Triglycerides must increase by about 5000 mgldl for a 10 rnEq/L drop in the serum sodium concentration. A triglyceride concentration of 1000 mgldl would result in a fall in the sodium concentration of only about 2 mEq/L. On the other hand, blood becomes lipemic when the triglyceride concentration reaches 500 mgldl: thus, lipemic blood does not confirm the diagnosis of pseudohyponatremia although the absence of lipemia rules out hypertriglyceridemia-related pseudohyponatremia.
One needs to be careful because overly rapid correction may lead to the osmotic demyelination syndrome. This is especially true in patients who are asymptomatic or mildly symptomatic whose hyponatremia has developed slowly over several days. 9% saline, these patients will quickly restore their sodium concentration to the normal range. It is imperative to check the sodium concentration frequently in these patients during therapy. The treatment of hyponatremia secondary to thiazide diuretics is to stop the diuretics and liberalize sodium intake.