By David J. Leehey MD, Dr. Irfan Moinuddin MD
This pocket-sized ebook bargains scientific scholars, interns, and citizens a concise creation to the sector. basic care physicians, internists, surgeons, nurse practitioners, pharmacists, and medical professional assistants also will locate this booklet useful.
• sufficiently small to slot right into a coat pocket
• A necessary instructing reduction to nephrology fellows and faculty
• comprises tables of regularly occurring details — taking away the necessity for memorization
• sufferer circumstances at finish of every bankruptcy strengthen the concepts
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Extra resources for Handbook of Nephrology
1986). • • • • 42 Chapter 5 / Disorders of Plasma Sodium Concentration Case Study ACUTE HYPONATREMIA How should you treat plasma [Na+] 110 mmol per L in a 70-kg postoperative male patient with seizures and coma? He is clinically euvolemic. Since this is an emergency, the goal is to increase plasma [Na+] by 2 mmol/L/h, for example, to 120 mmol per L within 5 hours. As this is an emergency, use 3% saline (~500 mmol/L). 2 CHRONIC HYPONATREMIA How should you treat plasma [Na+] 110 mmol per L in a clinically hypovolemic but otherwise asymptomatic 60-kg female patient?
Normal TBW with ↑ TBNa+. , concentration of sodium in administered fluid is greater than urinary concentration). ■ Again, it should be obvious that the plasma sodium concentration per se gives no information about the TBNa+. ■ In the presence of ADH, normal kidneys can concentrate urine to a urine osmolality of 1,200 mmol per kg (in older patients, urine osmolality generally will increase only to the 700 to 1,000 mmol per kg range). Thus, if the daily solute load is 600 mmol per day, urine output can be as low as 500 ml per day (with lesser daily solute loads, daily urine output can be theoretically even lower when maximally concentrated).
It turned out that she had Gitelman syndrome. Gitelman syndrome is a defect in the distal sodium chloride cotransporter, and is also characterized by renal magnesium wasting. Gitelman syndrome is similar to being on a thiazide diuretic and is associated with hypomagnesemia and elevated urine magnesium and decreased calcium excretion. She was not just anxious! 22 Chapter 2 / Measurement of Renal Function References Bröchner-Mortensen J, Rödbro P. Selection of routine method for determination of glomerular filtration rate in adult patients.