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