By Robert W. Schrier MD
- Topics coated comprise: electrolyte and acid-base issues, UTI’s, kidney stones, glomerulonephritis and vasculitis, acute or continual renal failure, high blood pressure, and renal sickness in being pregnant and diabetes
- NEW content material on kidney sickness in diabetes.
- Time-saving define structure for simple quick-reference
- Practical instructions on drug dosing in sufferers with impaired kidney functionality, with particular tips on greater than 500 drugs
- Complete content material with superior navigation
- A robust seek that attracts effects from content material within the e-book, your notes, or even the web
- Cross-linked pages, references, and extra for simple navigation
- Highlighting instrument for simpler reference of key content material during the text
- Ability to take and percentage notes with neighbors and colleagues
- Quick reference tabbing to save lots of your favorite content material for future
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Extra info for Manual of Nephrology
Diagnostic approach to hyponatremia. ) urine sodium concentration, the kidney is functioning normally by conserving sodium in response to ECF volume depletion. This occurs with extrarenal fluid losses. Conversely, if the urinary sodium concentration is greater than 20 mEq/L in a hypovolemic hyponatremic patient, the kidney is not responding appropriately to the ECF volume depletion, and renal losses of sodium and water must be considered as the likely cause of the hyponatremia. 1. In a hypovolemic hyponatremic patient with a urinary sodium concentration of less than 10 to 20 mEq/L, a gastrointestinal (or “third space”) source of sodium and water losses must be sought.
Appear to relate to CNS function. Correction of hyponatremia with the V2 receptor antagonists has been shown to improve mental function. Other studies have shown improved gait when raising severe sodium concentrations in “asymptomatic” hyponatremic patients. Because falls and fractures, particularly in the elderly, are more common in hyponatremic patients, there are other clinical implications for using these V2 receptor antagonists to treat hyponatremia. These relatively safe antagonists, therefore, have potential to more effectively correct acute and chronic hyponatremia when compared with severe fluid restriction, demeclocycline, or urea.
If fluid intake has been restricted, the patient with Addison disease may not present with hyponatremia, and hyperkalemia may not be present if the ECF volume depletion is not severe. Therefore, a high index of suspicion is necessary to make the diagnosis of primary adrenal insufficiency. These patients may present with nonspecific symptoms such as weight loss, anorexia, abdominal pain, nausea, vomiting, diarrhea, and fever. d. Osmotic diuresis obligating anion and cation excretion is another major diagnostic consideration in the hypovolemic hyponatremic patient with a urinary sodium concentration greater than 20 mEq/L.