I read the AHA guideline on how to manage general electrolyte imbalance and while their methods is practically the same, but i'm still confused on how would I convert the mEq to the volume needed. One thing I'm still confused with, is that how would I calculate drip per minute of the saline needed, would it be the same as how would I calculate maintenance fluid then?
in the european guidelines , it says that if symptoms don't improve, you keep with 3% with the aim of 1mmol/l/h increase of sodium. how do you calculate the rate of the syringe ?
wonderful tutorial. I have a question however, if the patient is dehydrated, how can we take that into account? I mean, the way used to calculate TBW is assuming the patient isn't dehydrated, so if they are, how do we deal with that? how can we know how much fluids to give to fix that dehydration along with the hyponatremia, and how to know when you would over-infuse the patient?
Thanks. When you say "dehydration", do you mean "hypovolemia"? You cannot be dehydrated and hyponatremic....by definition a hyponatremic patient is "water overloaded" (and not dehydrated).
890ml 3% hypertonic fluid for this patient if she or he got a sezure, but IV for how long, and is there any cautions for that IV, like using central IV. And how long will we intevest the sodium concentration again during that treatment? 4h or 6h or ? thank you for this evaluating lecture, hope get the best answer for my ques. thanks a lot
I usually give enough 3% saline until symptoms abate, and then stop. So even though the total amount of 3% saline needed to restore the patient to normonatremia (e.g. [Na] = 140 meq/L) might be 890 ml, I would not give that much. Only infuse through a central IV until symptoms resolve, then slowly raise the [Na] using fluid restriction and other conservative measures. That's what I would do.
How did you get the X value? How could I know how much 3% saline solution should be administered? This Patient had a Sodium deficit from 350. With 682ml 3% saline we correct this 350 sodium deficit. Thanks in advance.
I am departing from your greater lesson here; the proper calculation of 3% hyper-tonic saline. Thank you for that. But treating a patient with hyponatremic seizures, isn't it better to correct slowly? As a matter of fact, isn't fluid restriction often recommended first? As I understand it, a rapid saline delta - either higher or lower - is the cause of the seizures, rather than the low sodium itself? I ask because years ago a loved one had hypo-natremic seizures, and the recommendation was fluid restriction. I wanted hypertonic sodium administered, so we could correct the numbers quickly. But I was told that catering to a slow delta was the goal, as compared to normalizing the sodium level as fast as possible. Again; this was NOT the point of your instruction, so I hope no one minds this off topic question?
Great question. In general the onset of seizures due to water intoxication (hyponatremia) is dependent upon the rate of intoxication (speed at which hyponatremia occurred) and not always the degree of water intoxication (hyponatremia). One must match the rate of correction (with hypertonic saline) with the rate at which the intoxication first occurred in order to mitigate/abate the seizure. A patient can avoid neuronal excitability (seizure) with a [Na] of 105, for example, if the hyponatremia develops slowly, while another can develop seizures with a [Na] 120 if the speed of intoxication is rapid.
It's current sodium times body water .. here it's female so body water is half f whole weight that is 35 .. and curent sodium is 110 .. just cross them is 3850
35 liters of the patient total body water times the 110 mEq of sodium that you got from your serum electrolyte reading , that will give you the total body sodium . That’s how he got that number so basically 35Lt( 110) = 3850 mEq of Na+
@@feru5093 true. Because hypertonic saline interfere with The brain's ability to recapture the solutes lost from the cells and sudden correction of sodium can cause osmotic injury to the neurons associated with demyelination, called central pontine myelinosis or osmotic demyelination syndrome.
The problem is that in practice we have ampoules of 3% NaCl of 10 cc only and we do not have liter of 3% NaCl so how can we solve this problem
Thanks for the video,
If the patient has chronic hyponatremia or we do not know the duration, is it safe to increase the sodium 10 points that fast
I read the AHA guideline on how to manage general electrolyte imbalance and while their methods is practically the same, but i'm still confused on how would I convert the mEq to the volume needed. One thing I'm still confused with, is that how would I calculate drip per minute of the saline needed, would it be the same as how would I calculate maintenance fluid then?
in the european guidelines , it says that if symptoms don't improve, you keep with 3% with the aim of 1mmol/l/h increase of sodium. how do you calculate the rate of the syringe ?
wonderful tutorial.
I have a question however, if the patient is dehydrated, how can we take that into account?
I mean, the way used to calculate TBW is assuming the patient isn't dehydrated, so if they are, how do we deal with that?
how can we know how much fluids to give to fix that dehydration along with the hyponatremia, and how to know when you would over-infuse the patient?
Thanks.
When you say "dehydration", do you mean "hypovolemia"? You cannot be dehydrated and hyponatremic....by definition a hyponatremic patient is "water overloaded" (and not dehydrated).
@@nephondemand i see.
Well, say the patient is hypervolumic, how can we give fluids but also not overload the patient?
890ml 3% hypertonic fluid for this patient if she or he got a sezure, but IV for how long, and is there any cautions for that IV, like using central IV. And how long will we intevest the sodium concentration again during that treatment? 4h or 6h or ? thank you for this evaluating lecture, hope get the best answer for my ques. thanks a lot
I usually give enough 3% saline until symptoms abate, and then stop. So even though the total amount of 3% saline needed to restore the patient to normonatremia (e.g. [Na] = 140 meq/L) might be 890 ml, I would not give that much. Only infuse through a central IV until symptoms resolve, then slowly raise the [Na] using fluid restriction and other conservative measures. That's what I would do.
Is there a reason why only central iv lines must be used for 3 %Nacl?
Confused...
How did you get the X value? How could I know how much 3% saline solution should be administered?
This Patient had a Sodium deficit from 350. With 682ml 3% saline we correct this 350 sodium deficit.
Thanks in advance.
The Safest method is to use Madias Formula
0.4×(135-pt level sodium)* body wt = Na deficit
Explain with this formula
I am departing from your greater lesson here; the proper calculation of 3% hyper-tonic saline. Thank you for that.
But treating a patient with hyponatremic seizures, isn't it better to correct slowly? As a matter of fact, isn't fluid restriction often recommended first? As I understand it, a rapid saline delta - either higher or lower - is the cause of the seizures, rather than the low sodium itself?
I ask because years ago a loved one had hypo-natremic seizures, and the recommendation was fluid restriction. I wanted hypertonic sodium administered, so we could correct the numbers quickly. But I was told that catering to a slow delta was the goal, as compared to normalizing the sodium level as fast as possible.
Again; this was NOT the point of your instruction, so I hope no one minds this off topic question?
Great question. In general the onset of seizures due to water intoxication (hyponatremia) is dependent upon the rate of intoxication (speed at which hyponatremia occurred) and not always the degree of water intoxication (hyponatremia). One must match the rate of correction (with hypertonic saline) with the rate at which the intoxication first occurred in order to mitigate/abate the seizure.
A patient can avoid neuronal excitability (seizure) with a [Na] of 105, for example, if the hyponatremia develops slowly, while another can develop seizures with a [Na] 120 if the speed of intoxication is rapid.
Any one solve this equation how i get 890 ml
what is that number (3850 meq Na+) ?
is it constant?
and from where did u get it?
It's current sodium times body water .. here it's female so body water is half f whole weight that is 35 .. and curent sodium is 110 .. just cross them is 3850
@@MrShowkat1 why it's 110 ? While we consider total body water, we should take intracellular Na ions as well? Any clarifications pls
@@cmnaveenmusic 110 is the patient's current serum Na and tbw is this 110xbody weight which is 70in this case
Excellent , loved it
Good on you.
God bless you
why do you have 3850 ? i dont understand ?? please! help me
35 liters of the patient total body water times the 110 mEq of sodium that you got from your serum electrolyte reading , that will give you the total body sodium . That’s how he got that number so basically 35Lt( 110) = 3850 mEq of Na+
I got 1.12 Lts, don't know how you got 890 mL, thank you!
Many thanks!
890ml in 24hours infusion or bolus ?
Ishan Banerjee Never infuse bolus in sodium cases
@@feru5093 true. Because hypertonic saline interfere with The brain's ability to recapture the solutes lost from the cells and sudden correction of sodium can cause osmotic injury to the neurons associated with demyelination, called central pontine myelinosis or osmotic demyelination syndrome.
You can only give up to 300mL of NaCl 3% bolus