AZCEP Posted June 13, 2008 Share Posted June 13, 2008 Hyponatremic and a low BUN, eh? Link to comment Share on other sites More sharing options...
Mateo_1387 Posted June 13, 2008 Share Posted June 13, 2008 After looking up lab values, one that stuck out for me was the hyponatremia. Some of the effects of hyponatremia are brain swelling, which would account for the narrowing of the ventricles. Also hyponatremia can cause malice, nausea, convulsions, and coma. Link to comment Share on other sites More sharing options...
Mateo_1387 Posted June 13, 2008 Share Posted June 13, 2008 And along with what AZCEP said, the low BUN level, this would account for his body trying to keep all the Na+ it can. Link to comment Share on other sites More sharing options...
chbare Posted June 13, 2008 Author Share Posted June 13, 2008 Ok, so we have identified hyponatremia. In fact, this patient is profoundly hyponatremic. Now, we have to ask ourselves why? Well, you have two major causes of hyponatremia. First, the body somehow loses sodium, or second, the body does not actually loose sodium. The sodium simply becomes diluted. With the history and other labs, can we figure out what is causing this problem? Take care, chbare. Link to comment Share on other sites More sharing options...
AZCEP Posted June 13, 2008 Share Posted June 13, 2008 SIADH? Link to comment Share on other sites More sharing options...
chbare Posted June 13, 2008 Author Share Posted June 13, 2008 You nailed it. The patient does have SIADH (Syndrome of inappropriate Antidiuretic Hormone). His levels of ADH are elevated causing the kidneys to retain water. The patient is overloaded with fluid and dilutional hyponatremia is present. In addition, a low serum osmolality is appreciated. The hyponatremia causes water to shift into the cellular space. The brain is especially sensitive to this fluid shift and cerebral edema along with neurological dysfunction occurs. How can we treat this patient? What is the most likely cause of his SIADH with the history that we have obtained? Take care, chbare. Link to comment Share on other sites More sharing options...
AZCEP Posted June 14, 2008 Share Posted June 14, 2008 Since we have vascular access and his airway secured, I'd be hesitant to start messing with things too much. Sodium bicarbonate could help with the hyponatremia, but it has to be infused pretty slowly. Another option would be hypertonic saline (3%) again with slow infusion rates. Keep him sedated, and manage seizures with BZDs, also manage the other electrolytes that will be off a bit. Perhaps some mannitol? Link to comment Share on other sites More sharing options...
ERDoc Posted June 14, 2008 Share Posted June 14, 2008 If this guy is still seizing he needs hypertonic saline administered until the seizure stops. This guy is extremely sick and needs airway management and treatment right away. We can figure out the cause of the SIADH later, but it would be a good time to review the causes. Link to comment Share on other sites More sharing options...
Mateo_1387 Posted June 14, 2008 Share Posted June 14, 2008 How about an undiagnosed Tumor on the Pituitary Gland. I am just giving some guesses off the top of my head. Of course I guess it is also possible for his drug dealer to be giving him vasopressin instead of heroin. Not really. Link to comment Share on other sites More sharing options...
chbare Posted June 14, 2008 Author Share Posted June 14, 2008 Good, we will most likely need to administer hypertonic saline. I think diuretics would also be a good therapy to consider. So, how quickly are we going to administer the hypertonic saline and when do we start backing off, or do we normalize serum sodium? When considering the cause, think about the patients respiratory symptoms. Take care, chbare. Link to comment Share on other sites More sharing options...
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