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Nephrology

Electrolyte disorders   

Questions discussed in this category

What is your approach to discharge planning for a patient with chronic SIADH who is admitted with asymptomatic acute-on-chronic hyponatremia?
How do you establish an acceptable baseline serum sodium? How do you decide between non-pharmacological interventions, such as fluid restriction vs th...
1 Answer available
Are there instances when you recommend central line access when treating a patient using 3% sodium chloride for management of severe hyponatremia?
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
What is your approach to managing asymptomatic severe hyponatremia secondary to impaired free water clearance in a patient with oliguric acute kidney injury who is not on renal replacement therapy?
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
Are there instances when you use a 3% sodium chloride infusion for patients with chronic hyponatremia secondary to SIADH but who are asymptomatic or have only mild symptoms?
2 Answers available
Are there instances when you recommend initiation of hemodialysis for patients with severe symptomatic hypercalcemia?
2 Answers available
Would you start a vaptan or monitor an asymptomatic patient with reset osmostat and an average sodium of 126 meq/L?
2 Answers available
Is there a role for cinacalcet in the management of PTHrP-mediated hypercalcemia?
1 Answer available
How do you approach checking an aldosterone to renin ratio in an outpatient with hypertension and hypokalemia that is difficult to correct with oral potassium replacement?
Would you check an aldosterone to renin ratio in the setting of hypokalemia, knowing that the result will be impacted by the potassium 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., PMID 38320180
5 Answers available
Do you use SGLT2 inhibitors in the management of SIADH?
Refardt et al., PMID 36396331
2 Answers available
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?
3 Answers available
Do you still use the urinary anion gap to estimate renal ammonium excretion in patients with a non-anion gap metabolic acidosis, given its limitations?
6 Answers available
What is the recommended workup for PTH-independent hypercalcemia secondary to an elevated 1,25-dihydroxyvitamin D level?
1 Answer available
Do you routinely check serum phosphorus levels after IV iron therapy?
If not, are there specific instances where you would recommend checking phosphorus levels and at what frequency for monitoring/treatment?
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
How do you approach a patient with biochemical evidence of primary hyperparathyroidism, but normal parathyroid scan?
5 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
Do you try to treat the acidosis resulting from acetazolamide in patients with IIH?
1 Answer available
Do you interpret failure to develop hypernatremia with prolonged water deprivation (such as for 12 hours) as evidence against diabetes insipidus even if the urine osmolality is just below normal?
For a patient whose sodium remains 142 despite water deprivation from 8 pm to 8 am, with urine osm of about 500, is further testing needed?
2 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
What is your approach to preventing exercise-associated hyponatremia?
2 Answers available
What are your top takeaways from ASN 2024?
1 Answer 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
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 have a preferred oral magnesium formulation for patients with hypomagnesemia secondary to Gitleman syndrome and who also have chronic diarrhea?
1 Answer available
Do you avoid terlipressin for patients with hepatorenal syndrome who have a serum sodium level less than 125 mEq/L?
2 Answers available
What is your approach to managing hypokalemia in patients with Bartter syndrome who are on high doses of potassium chloride but cannot tolerate amiloride or ACEi/ARBs due to low blood pressures?
1 Answer available
Is the phosphorus-lowering benefit of patiromer compelling enough to switch a patient with chronic hyperkalemia and hyperphosphatemia from sodium zirconium cyclosilicate to patiromer?
2 Answers available
What further work up do you recommend for patients with a chronic high anion gap metabolic acidosis with normal eGFR who have been ruled out for lactic acidosis, ketosis, toxic alcohols, and other usual culprits of high anion gap metabolic acidosis?
3 Answers available
What is your approach to differentiating diabetes insipidus from primary polydipsia in the outpatient setting?
1 Answer available
What are your next steps when managing patients with suspected Gitelman syndrome for whom genetic testing reveals variants of uncertain significance or novel mutations not well characterized?
2 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
Is there a role for SGLT-2 inhibitors in the treatment of chronic hypomagnesemia?
1 Answer available
What is your daily correction goal for those patients being treated for hypernatremia?
2 Answers available
Do you recommend obtaining a spot urine or 24-hour urine magnesium measurement when evaluating patients with persistent hypomagnesemia of unknown etiology?
3 Answers available
How often do you check urine osmolality and urine electrolytes when treating hospitalized patients with hyponatremia?
2 Answers available
What is your approach to using bisphosphonates in those with severe hypercalcemia and chronic kidney disease?
1 Answer available
What are your top takeaways from ASN 2023?
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 consider hyperuricemia as a potential etiology of an anion gap metabolic acidosis in patients with elevated uric acid levels and no other readily explainable causes of acidosis?
1 Answer available
What additional studies would you obtain for a patient with end stage kidney disease on hemodialysis who has persistent hypercalcemia and low PTH?
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
Can an acid loading test be used to assist with the diagnosis of RTAs other than an incomplete distal RTA?
1 Answer available
Does your goal rate of correction in patients with chronic hypoosmolar hyponatremia differ based on the degree of hypoosmolarity?
4 Answers available
Do you recommend stopping Vitamin D supplementation in a patient with hypercalcemia and a low 25(OH)D level?
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
How do you treat sarcoidosis associated hypercalcemia in a patient with adenopathy and no other signs of systemic involvement?
1 Answer available
What degree of hyperkalemia do you tolerate for those with proteinuric chronic kidney disease and persistently elevated serum potassium levels?
1 Answer available
What is your approach to managing hypocalcemia following a parathyroidectomy in patients with end stage kidney disease?
1 Answer available
Do you prefer transtubular potassium gradient (TTKG) or urine potassium to urine creatinine ratio when evaluating patients with abnormal potassium levels?
1 Answer available
How do you manage calcium and vitamin D supplementation in patients with sarcoidosis on chronic steroids?
1 Answer available


Papers discussed in this category

Clin Chim Acta, 2020 Oct 20
Diagnostic value of parameters from a spot urine sample for renal potassium loss in hypokalemia.
Am J Kidney Dis, 2019 Jun 19
Physiology and Pathophysiology of Potassium Homeostasis: Core Curriculum 2019.
Curr Opin Nephrol Hypertens, 2011 Sep
Intrarenal urea recycling leads to a higher rate of renal excretion of potassium: an hypothesis with clinical implications.
Kidney Int, 2002 Jul
Hyperkalemia: An adaptive response in chronic renal insufficiency.
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.
AACE Clin Case Rep, 2020 Aug 06
METHOTREXATE TREATMENT FOR SARCOIDOSIS-INDUCED HYPERCALCEMIA.
Am J Med, 1987 Jun
Hydroxychloroquine treatment of hypercalcemia in a patient with sarcoidosis undergoing hemodialysis.
Sarcoidosis Vasc Diffuse Lung Dis, 2012 Mar
Hypercalcemia from sarcoidosis successfully treated with infliximab.
Arch Osteoporos, 2017 Jul 19
Glucocorticoid sparing effect of zoledronic acid in sarcoid hypercalcemia.
BMJ Case Rep, 2022 Jul 08
Hungry bone syndrome like presentation following single-dose denosumab for hypercalcaemia secondary to sarcoidosis with IgA nephropathy.
Arthritis Res Ther, 2014 Mar 24
Bone fragility in sarcoidosis and relationships with calcium metabolism disorders: a cross sectional study on 142 patients.
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.
The New England journal of medicine, 2024 Oct 26
Bi- and Monoallelic Variants and Chronic Kidney Disease in West Africans.
Atencion primaria, 1997 Sep 30
[The existing differences between adolescent girls served on a first visit in a family planning center in 2 time periods].
The New England journal of medicine, 2024 Oct 25
Long-Term Effects of Empagliflozin in Patients with Chronic Kidney Disease.
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.
JAMA,
Effects of Iron Isomaltoside vs Ferric Carboxymaltose on Hypophosphatemia in Iron-Deficiency Anemia: Two Randomized Clinical Trials.
PloS one, 2016 Dec 01
Choice of High-Dose Intravenous Iron Preparation Determines Hypophosphatemia Risk.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2022 Jul 08
Beyond the Urine Anion Gap: In Support of the Direct Measurement of Urinary Ammonium.
Clinical journal of the American Society of Nephrology : CJASN, 2025 Apr 25
The Concept, Usefulness, and Limitations of the Urine Anion Gap.
Journal of the American Society of Nephrology : JASN, 2021 Mar 05
The Urine Anion Gap: Common Misconceptions.
Cardiovascular diabetology, 2023 Aug 02
Lack of durable natriuresis and objective decongestion following SGLT2 inhibition in randomized controlled trials of patients with heart failure.
The New England journal of medicine, 2023 Oct 19
The Syndrome of Inappropriate Antidiuresis.
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2024 Sep 27
Hyponatraemia-treatment standard 2024.
Cureus, 2025 Jan 12
A New Quantitative Approach for Correcting Cirrhosis-Associated Hyponatremia by Inducing Negative Water Balance in Excess of Negative Sodium and Potassium Balance.
The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses, 2017 Jun
Complication Rates of 3% Hypertonic Saline Infusion Through Peripheral Intravenous Access.
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 2018 Mar 01
Association between continuous peripheral i.v. infusion of 3% sodium chloride injection and phlebitis in adults.
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2016 Dec
Safety of Continuous Peripheral Infusion of 3% Sodium Chloride Solution in Neurocritical Care Patients.
The Journal of emergency medicine, 2019 Feb 08
Safety of Peripheral Line Administration of 3% Hypertonic Saline and Mannitol in the Emergency Department.

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