Episode 93: Hyponatremia treatment.    Catherine and Dr. Saito discuss how to treat hyponatremia in an effective and safe way, especially when the hyponatremia is severe.Introduction: What is sodium?By Hector Arreaza, MD. Read by Alyssa Der Mugrdechian, MD; and Gina Cha, MD.  Sodium is a white metal that does not exist in nature in its free form. In its solid form, it’s so soft that you could cut it like butter with a knife. It is the sixth most common element in the earth’s crust. Even though sodium only makes up to 0.2% of our body weight, it plays a key role in nerve conduction, muscle contraction, and most importantly regulating water balance. Today we will be talking about low sodium, known as hyponatremia. We will focus on how to treat hyponatremia and will mention some common causes and symptoms. We hope you can learn something from us today.This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice.___________________________Hyponatremia treatment.   By Catherine Nguyen, MS4, Ross University School of Medicine. Comments by Steven Saito, MD; and Hector Arreaza, MD.  DEFINITION: Serum sodium concentration impairment in free water excretion > hypoosmolality of serum-Diuretics (thiazides first 1-2 weeks)  -SIADH (Syndrome of inappropriate ADH, I call it the syndrome of EXCESSIVE ADH to help me remember it), caused by common meds.-Heart failure (low cardiac output) & cirrhosis (arterial vasodilation impairment) > decreased tissue perfusion (baroreceptors in carotid sinus senses reduction in pressure) > stimulus of ADH-GI fluid loss (diarrhea, vomiting)-CNS disturbances (stroke, hemorrhage, infections, psychosis, trauma) > increases ADH release-Malignancies > ectopic production of ADH (small cell carcinoma)-Drugs > SSRI, carbamazepine, cyclophosphamide -Potomania > patient drinks large amounts of beer and decreased intake of foods (solids). PRESENTATION:-Asymptomatic-Nausea & malaise earliest findings (125-130)-Headache, lethargy, muscle cramps, confusion/AMS, and eventually seizures, coma, and respiratory arrest (115-120)-Acute hyponatremia encephalopathy may be reversible, but permanent neurologic damage or death can occur. TREATMENT: Clinic: Chronic cases of hyponatremia may require spread-out treatment. Hyponatremia is never normal. -Mild hyponatremia > concentration of 130 to 134 mEq/L: NO treatment with hypertonic saline. Rather, the initial approach includes general measures that are applicable to all hyponatremic patients (i.e., identify and discontinue drugs that could be contributing to hyponatremia; identify and, if possible, reverse the cause of hyponatremia; and limit further intake of water [e.g., fluid restriction, discontinue hypotonic intravenous infusions]. -Moderate hyponatremia > concentration of 120 to 129 mEq/L ASYMPTOMATIC - 50 mL bolus of 3 percent saline (ie, hypertonic saline) to prevent the serum sodium from falling further.SYMPTOMATIC – (call ICU) 100 mL bolus of 3 percent saline, followed, if symptoms persist, with up to two additional 100 mL doses (to a total dose of 300 mL); each bolus is infused over 10 minutes. -Severe hyponatremia > concentration of

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