Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple by Richard Arthur Preston

By Richard Arthur Preston

Univ. of Miami, FL. Concise instruction manual on fixing difficulties pertaining to complicated fluid, electrolyte, and acid-base issues. For scientific scholars, interns, citizens, nurses and nurse practitioners, and first-year nephrology fellows. Softcovers.

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The sodium electrode technique is now in wide clinical use, so pseudohyponatremia is especially rare nowadays. Hyponatremia with Hypertonicity Hyponatremia with hypertonicity is another special case of hyponatremia, most often caused by severe hyperglycernia in uncontrolled diabetes mellitus. The sodium is low because of transcellular shifting of water, but both tonicity and measured serum osmolality are very high. Because glucose is an effective osmole, the high glucose concentration causes water movement from the intracellular compartment to the extracellular compartment, thereby reducing the extracellular sodium concentration.

Hyponatremia with markedly increased tonicity, usually due to profound hyperglycemia. 45% saline This is the only situation in which a patient with hyponatremia might be given hypotonic fluids. Measured and calculated Posm must be severely elevated due to marked hyperglycemia. Renal failure Water restriction. Restrict water only if hyponatremia is present. 9% saline. Usually in setting of vomiting. 9% saline. Edematous states Water restriction for hyponatremia. Sodium restriction and loop diuretics to remove edema.

The net result is the delivery of 1 liter of free water. Pure water cannot be given intravenously because it causes hemolysis. D5W is frequently used to administer medications. One advantage of D5W is that it does not deliver unwanted sodium and therefore causes ECFV overload less readily than do saline solutions. D5W may be given at a low rate (10-25 cc/hr) when it is desired to "keep a vein open" (KVO) for intravenous medications. Some situations in which D5W might be used are: Correction of hypernatremia-watch the patient carefully for hyperglycemia or glucosuria Delivery of medications in a non-diabetic patient As KVO in states of ECFV overload-D5W contains no sodium and will not further expand the ECFV as much as will saline solutions 4) Potassium supplementation is best given orally when feasible.

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