Electrolyte disorders&nbsp;&nbsp;&nbsp;

What is your approach to preventing exercise-associated hyponatremia?

Do you recommend fluid restriction in addition to other management strategies for patients with hyponatremia due to SIADH?

6 Answers available

How has the FLUID trial, which showed no significant difference in death or readmission rates between Lactated Ringer’s solution and normal saline, influenced your approach to IV fluid management?

McIntyre et al., PMID 40503714

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...

Are there instances when you recommend central line access when treating a patient using 3% sodium chloride for management of severe hyponatremia?

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?

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?

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?

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?

Are there instances when you recommend initiation of hemodialysis for patients with severe symptomatic hypercalcemia?

Would you start a vaptan or monitor an asymptomatic patient with reset osmostat and an average sodium of 126 meq/L?

Is there a role for cinacalcet in the management of PTHrP-mediated hypercalcemia?

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?

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

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?

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?

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?

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?

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?

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?

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?

Do you try to treat the acidosis resulting from acetazolamide in patients with IIH?

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?

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?

What are your top takeaways from ASN 2024?

What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?

What is your daily correction goal for those patients being treated for hyponatremia?

Do you recommend plasmapheresis for treatment of patients with osmotic demyelination?

Do you recommend prophylactic post-operative use of an intravenous calcium infusion for patients with ESKD who undergo subtotal parathyroidectomy for secondary hyperparathyroidism?

Do you administer calcium to patients with K > 6.5 without EKG changes?

What is your approach to interpreting urine studies in patients hospitalized for hyponatremia who have recently received intravenous fluids containing sodium chloride?

Do you have a preferred oral magnesium formulation for patients with hypomagnesemia secondary to Gitleman syndrome and who also have chronic diarrhea?

Do you avoid terlipressin for patients with hepatorenal syndrome who have a serum sodium level less than 125 mEq/L?

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?

Is the phosphorus-lowering benefit of patiromer compelling enough to switch a patient with chronic hyperkalemia and hyperphosphatemia from sodium zirconium cyclosilicate to patiromer?

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?

What is your approach to differentiating diabetes insipidus from primary polydipsia in the outpatient setting?

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?

Do you use acetazolamide to aid diuresis in patients with acute on chronic respiratory acidosis with significantly elevated serum bicarbonate levels?

Is there a role for SGLT-2 inhibitors in the treatment of chronic hypomagnesemia?

What is your daily correction goal for those patients being treated for hypernatremia?

Do you recommend obtaining a spot urine or 24-hour urine magnesium measurement when evaluating patients with persistent hypomagnesemia of unknown etiology?

How often do you check urine osmolality and urine electrolytes when treating hospitalized patients with hyponatremia?

What is your approach to using bisphosphonates in those with severe hypercalcemia and chronic kidney disease?

What are your top takeaways from ASN 2023?

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?

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?

What additional studies would you obtain for a patient with end stage kidney disease on hemodialysis who has persistent hypercalcemia and low PTH?

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?

Can an acid loading test be used to assist with the diagnosis of RTAs other than an incomplete distal RTA?

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?

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)

How do you treat sarcoidosis associated hypercalcemia in a patient with adenopathy and no other signs of systemic involvement?

What degree of hyperkalemia do you tolerate for those with proteinuric chronic kidney disease and persistently elevated serum potassium levels?

What is your approach to managing hypocalcemia following a parathyroidectomy in patients with end stage kidney disease?

Do you prefer transtubular potassium gradient (TTKG) or urine potassium to urine creatinine ratio when evaluating patients with abnormal potassium levels?

How do you manage calcium and vitamin D supplementation in patients with sarcoidosis on chronic steroids?