noelle
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HOW DO WE MANAGE HYPONAT. IF SYMPTOMATIC DO WE GIVE 3% SALINE OR NOT . COZ CTB SAYS [ ON THE EXAM DONT EVEN THINK ABT HYPERTONIC SALINE COZ OF CENTRAL P MYELINOLYSIS ] BUUTTT... AS USUAL UW SAYS : GO FOR IT!!! IN A DILEMMA :?
HELP ELM , LUCKY/, MIKY ANYBODY :?:
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| tamriko
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I think UW is correct in this matter. In severe hyponatremia pt should be given hypertonic saline, but plasma natrium should raised no more than 8mmol/L during first 24 hours. :?
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| ELM
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I'll say listen to your gut and pick the answers... since all these sourses conflict each other. I would give hypertonic saline in severly symphtomatic patient you know, if someone is neurologicly severly compromised and in coma and his brain is saying bye-bye to us then you gotta give it to him nomatter what other risk you got there, just give it slow.
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ELM
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| mash
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It depends on the onset
if it is acute in onset --go for hypertonic saline
pts with acute hyponatremia are not likely to develop pontine myelinolysis bcoz brain doesnt get time to adapt (i.e there is no change in intracellular charged protein moeities)
if it is gradual in onset -- go fr isotonic saline
bcoz prolonged hyponatremia followed by rapid correction leads to edema-->osmotic myelinolysis( bcoz brain gets time to adapt to hyponatremia)
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| mikyro
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HOW DO WE MANAGE HYPONAT. IF SYMPTOMATIC DO WE GIVE 3% SALINE OR NOT . COZ CTB SAYS [ ON THE EXAM DONT EVEN THINK ABT HYPERTONIC SALINE COZ OF CENTRAL P MYELINOLYSIS ] BUUTTT... AS USUAL UW SAYS : GO FOR IT!!! IN A DILEMMA
HELP ELM , LUCKY/, MIKY ANYBODY
GUYS...USMLE tries to trick you with that :idea: !!!!. Be careful :idea: !!!!
Never pick hypertonic saline in step 1/2 :idea: !!!!!!!
Here's what step 1/2 wants from you :wink: . Please remmeber this on the exam day :!: !!!!:
hyponatremia - give hypertonic saline only if the pacient is experiencing seizures in fron of your eyes (you must witness seizures; don't rely on what others tell you !!!). In this case, you may give hypertonic saline. But be extremely precacious; step 1/2 tries to trick you...they may also give you an MRI for example with some changes in the pons !!!- so think of central pontine myelinosis due to overzealous correction of hyponatremia. And they ask you how this could have been prevented - simple: you should have given normal saline.
For step 1/2, never chose hypertonic saline unless patient develops seizures in from of you. Give normal saline and gradually correct hyponatremia.
There are many cases with hyponatremia. Besides, what if hyponatremia is due to too much water intake? Be careful - restric water intake here first; then if hyponatremia not corrected, give normal saline; do not give hypertonic saline here. You may kill the patient.
Hope it helped.
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the same miky - always ready to help my patients and friends as well
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| lucky
Forum Guru
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crush says that normal saline is the correct answer for the boards 99 out of 100 times and i agree with it. what miky says is right. i have read the thing about patient having seizures in front of u but i don't remember where i read it. anyway n/s is usually the right answer for the exam.correction should not be faster than 12meq/d.
if uw has a different opinion than the case scenario must have been an exception not the rule. uw is good and they have logical expl. but we need to interpret the q correctly.
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