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Vasopressin

Contents

  1. 1 Hyponatraemia
    1. 1.1 Fluids composition

Hyponatraemia

Src: Thompson, Wyth teach 5-Dec-08
see also: U&E | Lancet:Sodium(Review)1998
Eg vomiting alcoholic, hypotensive, lo Na: Hypovolaemic hyponatraemia: = APPROPRIATE antidiuresis: lo Na, hi U, hi Crea, lo Osm, hi U-Osm: treat with N. Saline
Eg TBI: lo Na, UOP 1.1L/d=lo: SIADH: INAPPROPRIATE antidiuresis: lo Na, lo U, lo Crea, lo Osm, hi U-Osm: treat with fluid restriction, consider demeclocycline
Eg SAH: lo Na, UOP 7L/d: CEREBRAL SALT WASTING syndr: initially hi BNP, ANP -> fluid depletion -> hi AVP -> lo Na

Clinical approach:
  • Hypovolaemia: low BP, hi HR, dcrd skin turgor, hi U
    • U-Na<20
      • Extra-renal loss: GI:D&V, 3rd space:burns, pancreatitis
    • U-Na>40

  • Euvolaemia
    • U-Na<20

    • U-Na>40

  • Hypervolaemia
    • U-Na<20

    • U-Na>40

Fluids composition

Gastric: Na:20-80, K:5-20, Cl:100-150,
Diarrhoeal: Na:10-90, K:10-80, Cl:10-110,
Sweat: Na:10-30, K:3-10, Cl:10-35,
Bile: Na:120-140, K:5-15,

         

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