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The Curbsiders Internal Medicine Podcast | MedEd | FOAMed | Internist | Hospitalist | Primary Care | Family Medicine

Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview national and international experts to bring you clinical pearls and practice changing knowledge. Doctors Matthew Watto, Stuart Brigham, and Paul Williams deliver some knowledge food for your brain hole. No boring lectures here, just high value content and a healthy dose of humor. Fantastic podcast for Internal Medicine, Family Medicine, Primary Care, and Hospital Medicine. Topics include heart disease, obesity, diabetes, cardiac imaging, migraines, fibromyalgia, hypertension, cholesterol, osteoporosis, insomnia, testosterone, functional medicine, dementia, and more!
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Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview national and international experts to bring you clinical pearls and practice changing knowledge. Doctors Matthew Watto, Stuart Brigham, and Paul Williams deliver some knowledge food for your brain hole.

thecurbsiders@gmail.com

Jul 17, 2017

Step up your salt game. We deconstruct hyponatremia with expert tips from our Chief of Nephrology, Dr. Joel Topf aka @kidney_boy aka The Salt Whisperer. Topics include: true versus false hyponatremia, SIADH, tea and toast/beer potomania, safe rates of sodium correction, fluid restriction, salt tablets, IV fluid choice, DDAVP clamps, and more.

Full show notes available at http://thecurbsiders.com/podcast

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Case: 85yo F with anxiety, asthma, HTN (on a CCB), hypothyroidism with TSH of 3 on therapy. Sodium was 128 from previous values 134-137 mg/dL. She is more fatigued than usual.

Time Stamps

00:00 Intro

03:00 Guest interview

06:45 Pick of the week w/Dr. Topf

15:50 Clinical case of hyponatremia

17:18 False hyponatremia normal osmolality

19:04 False hyponatremia high osmolality

20:06 Understanding why osmolality matters

22:58 Workup false hyponatremia

24:15 Recap of discussion so far

25:10 ADH dependent vs independent hyponatremia

26:30 Psychogenic polydipsia

28:45 Renal failure and hyponatremia

29:33 Tea and toast, and Beer Drinker’s potomania

34:42 ADH dependent hyponatremia

37:45 Volume versus osmolality

39:30 Volume status exam

44:44 Additional testing with urine lytes and uric acid

47:00 Treatment for SIADH

52:12 Discussion of the vaptans

57:51 Additional testing in SIADH

62:20 When to admit patient for hyponatremia

63:29 Clinical case of hyponatremia complications

68:26 Fluids and rate of correction

73:06 DDAVP clamp

76:00 Moderate hyponatremia

78:05 Diuretic dosing DOES matter!

81:29 Loop diuretics for SIADH

83:55 Take home points

86:55 Outro

Tags: hyponatremia, salt, sodium, SIADH, ADH, vasopressin, fluids, electrolytes, kidney, nephrology, osmolality, urine, concentration, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

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