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Hospital Medicine

Electrolyte disorders   

Questions discussed in this category

Would you recommend starting tolvaptan at 7.5 mg per day, which is half the typical starting dose, to reduce the risk of overcorrection in an inpatient with SIADH and a serum sodium level of 122 mEq/L?
2 Answers available
How would you manage hemodialysis for an ESKD patient who presents with a phosphorus of 1.6 mg/dl and potassium of 6.5 mEq/L without ECG changes?
2 Answers available
What factors influence your decision to start salt tablets, urea, or a vaptan first in the management of a patient diagnosed with SIADH?
3 Answers available
What is your calcium level threshold for initiating targeted calcium lowering therapies for patients with an acute kidney injury believed secondary to renal vasoconstriction and volume depletion?
1 Answer available
Would you consider treating hypercalcemia with CRRT and regional citrate anticoagulation for a dialysis dependent patient who does not respond to bisphosphonate therapy and low calcium dialysate bath?
2 Answers available
Do you routinely use 3% sodium chloride and desmopressin to correct hypovolemic hyponatremia in an asymptomatic patient with serum sodium of less than 120 mEq/L?
3 Answers available
What is your preferred intravenous fluid type for matching volume loss in a patient with persistent surgical drain output and pre-renal acute kidney injury?
1 Answer available
In a patient with severe hyponatremia and acute kidney injury in the setting of hypovolemic shock, would fluid resuscitation take precedence over the rate at which sodium is corrected?
3 Answers available
What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?
1 Answer available
Are there instances when you recommend initiation of hemodialysis for patients with severe symptomatic hypercalcemia?
1 Answer available
What is your daily correction goal for those patients being treated for hyponatremia?
1 Answer available
Do you recommend plasmapheresis for treatment of patients with osmotic demyelination?
1 Answer available
Do you recommend prophylactic post-operative use of an intravenous calcium infusion for patients with ESKD who undergo subtotal parathyroidectomy for secondary hyperparathyroidism?
1 Answer available
Do you administer calcium to patients with K > 6.5 without EKG changes?
3 Answers available
What is your approach to interpreting urine studies in patients hospitalized for hyponatremia who have recently received intravenous fluids containing sodium chloride?
1 Answer available
Do you recommend fluid restriction in addition to other management strategies for patients with hyponatremia due to SIADH?
5 Answers available
Do you avoid terlipressin for patients with hepatorenal syndrome who have a serum sodium level less than 125 mEq/L?
2 Answers available
Do you recommend careful correction of serum sodium to avoid osmotic demyelination syndrome in patients who are found to have isoosmolar hyponatremia in the setting of an elevated BUN level?
2 Answers available
Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?
Seethapathy et al., NEJM
5 Answers available
Do you use acetazolamide to aid diuresis in patients with acute on chronic respiratory acidosis with significantly elevated serum bicarbonate levels?
3 Answers available
What is your daily correction goal for those patients being treated for hypernatremia?
2 Answers available
How often do you check urine osmolality and urine electrolytes when treating hospitalized patients with hyponatremia?
2 Answers available
Do you recommend checking urine sodium 2 hours after loop diuretic administration to determine the need for dose adjustment in a patient with acute decompensated heart failure?
1 Answer available
Do you recommend using dextrose based solutions to induce osmotic diuresis for euvolemic patients with acute kidney injury in the setting of a hemolytic condition?
1 Answer available
Do you use tolvaptan for management of hyponatremia related to heart failure given the side effect profile and lack of mortality benefit seen in a previous trial?
The EVEREST Outcome trial (Konstam et al., PMID 17384437)
1 Answer available
What is your approach to managing hypocalcemia following a parathyroidectomy in patients with end stage kidney disease?
1 Answer available


Papers discussed in this category

Clinical journal of the American Society of Nephrology : CJASN, 2019-05-07
Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients.
Curr Opin Cell Biol, 1995 Aug
Cell volume regulated transporters of compatible osmolytes.
Kidney international, 1997 Oct
Mannitol therapy revisited (1940-1997).
The American journal of medicine, 2016-05
Diagnosing and Treating the Syndrome of Inappropriate Antidiuretic Hormone Secretion.
Clinical journal of the American Society of Nephrology : CJASN, 2018-07-06
Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia.
Journal of critical care, 2023 May 13
Effects of correction rate for severe hyponatremia in the intensive care unit on patient outcomes.
The Journal of urology, 1992-06
Functional obstructive uropathy: a significant factor in the hyponatremia of psychogenic polydipsia?
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2013-04
Hypertonic saline and desmopressin: a simple strategy for safe correction of severe hyponatremia.
The New England journal of medicine, 2021 Mar 04
Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome.
Kidney Med, 2020 Jan-Feb
Equivalent Efficacy and Decreased Rate of Overcorrection in Patients With Syndrome of Inappropriate Secretion of Antidiuretic Hormone Given Very Low-Dose Tolvaptan.

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