@@calxxx Yup. In a secretory diarrhoea, water and electrolytes are secreted into the bowel lumen, causing HYPOnatremia, HYPOkalemia and metabolic acidosis. However in osmotic diarrhoea, only water is osmotically sucked into the bowel lumen, hence causing HYPERnatremia.
In a case in our ICUs with hypernatremia and AKI, our nephrology specialist assured me no case developing osmotic mylo. with dialysis in hypernatremia whether sudden drop or not. But I do not know why.
Osmotic demyelination syndrome as a result of rapid correction of hyponatremia probably does occur in patients on hemodialysis, but is far less common than in patients with equally dramatic swings in the serum sodium. It's not entirely known why this is true. I don't know if you have access to it, but there is a good discussion about this phenomenon in a journal article: "Does Uremia Protect against the Demyelination Associated with Correction of Hyponatremia during Hemodialysis?" by Oo, Smith, and Swan in Seminars in Dialysis (2003) - PubMed ID 12535304 In a patient who has developed AKI and hypernatremia due to severe dehydration, initiation of dialysis would be associated with a sudden drop in serum osmolarity, which would not cause demyelination, but rather cerebral edema and dialysis disequilibrium syndrome (which definitely does occur).
Sir you got it best and best explained in the simplest Version I could find.. thank you for all the hard efforts you put in this video and explaination
Sir, at 6:40 you mention chronic hyperkalemia as a cause of nephrogenic Diabetes insipidus. But your slide shows "hypokalemia", which one is correct? Other than that, great lecture, as always!
Hi Eric, thanks for the informative video. I had a few questions about the topic. GI loss ( diarrhea, vomiting...) was listed in both hypernatremia and hyponatremia. In hyponatremia, it is associated with decreased intravascular volume leading to ADH release and therefore causing hyponatremia. In hypernatremia, it is due to loss of hypotonic fluids. I am wondering loss of GI fluid was associated with hypernatremia if the loss is not much enough to activate the ADH release. But if severe enough loss of GI fluid would cause hyponatremia. Is it like what i said ? or anything i misunderstood. Thanks Eric!
Hello. For a patient who is taking fluid orally to correct Chronic Hypernatremia, since the recommended serum sodium concentration correction rate is 12 meq/L per day and 0.5 meq/L per hour. Does that mean the patient should not sleep while they are receiving treatment?
excuse me sir, i have a qestion regarding the development of hypernatremia due to DM. Generally, during DM a patient usually develops hyperglycemia which leads to excessive amounts of water moving out of the ICF compartment to ECF compartment ,leading to dilutional effect on serum sodium, causing hyponatremia.Hoping for fast reply from persons who can clarify.
DM can cause both hyponatremia and hypernatremia. You described the mechanism of hypertonic hyponatremia (your ECF osmolality is severely elevated due to increased ECF glucose secondary to DM, hence the hypertonic; ECF Water>ECF sodium --> hyponatremia). For hypernatremia you end up with excessive osmotic diuresis secondary to severe glucosuria which results in free water loss with little sodium loss and in turn results in a hypovolemic hypernatremia (loss of free water = hypovolemia; ECF salt>ECF water --> Hypernatremia). If someone attempted to correct this with drinking/infusion of free water then you would end up creating a hypovolemic hyponatremia (loss of free water = hypovolemia; but now ECF water>ECF salt --> hyponatremia!). Its highly unlikely you'd be able to fully correct the water imbalance to the point of euvolemia without causing severe hyponatremia and associated symptoms. Of course all of these mechanisms can overlap and just make it that much more confusing. Just learning this now but figured this would be good practice. If anyone has any corrections please, please do so as I barely understand it myself.
Can low potassium can trigger to get a high sodium in ur body? Coz my wife when we bring him to the hospital. The first cause is her hypokalemia. Even her breathing is getting worsed. Then after a day later her body is starting to recover. Then the doctor told us that her sodium in her body is getting high its 147.00mmol/L then she sleep and her heart rate is climbing up and down. And then she passed away while sleeping.
May I know how GI losses can be the cause for both hyponatremia and hypernatrmia ?
Wesley W as per Harrison’s , osmotic diarrhea leads to hypernatremia while secretory diarrhea leads to hypotonic diarrhea
@@calxxx Yup. In a secretory diarrhoea, water and electrolytes are secreted into the bowel lumen, causing HYPOnatremia, HYPOkalemia and metabolic acidosis. However in osmotic diarrhoea, only water is osmotically sucked into the bowel lumen, hence causing HYPERnatremia.
Amazing video! Even better explained than in Cecil!
In a case in our ICUs with hypernatremia and AKI, our nephrology specialist assured me no case developing osmotic mylo. with dialysis in hypernatremia whether sudden drop or not. But I do not know why.
Osmotic demyelination syndrome as a result of rapid correction of hyponatremia probably does occur in patients on hemodialysis, but is far less common than in patients with equally dramatic swings in the serum sodium. It's not entirely known why this is true. I don't know if you have access to it, but there is a good discussion about this phenomenon in a journal article: "Does Uremia Protect against the Demyelination Associated with Correction of Hyponatremia during Hemodialysis?" by Oo, Smith, and Swan in Seminars in Dialysis (2003) - PubMed ID 12535304
In a patient who has developed AKI and hypernatremia due to severe dehydration, initiation of dialysis would be associated with a sudden drop in serum osmolarity, which would not cause demyelination, but rather cerebral edema and dialysis disequilibrium syndrome (which definitely does occur).
Sir you got it best and best explained in the simplest Version I could find.. thank you for all the hard efforts you put in this video and explaination
thanx eric for fantastic videos
Awesome video. Totally makes sense. Thank you once again. Pleaee keep making more videos
Sir, at 6:40 you mention chronic hyperkalemia as a cause of nephrogenic Diabetes insipidus. But your slide shows "hypokalemia", which one is correct? Other than that, great lecture, as always!
It's HYPOkalemia and HYPERcalcemia.
Hi Eric, thanks for the informative video. I had a few questions about the topic.
GI loss ( diarrhea, vomiting...) was listed in both hypernatremia and hyponatremia.
In hyponatremia, it is associated with decreased intravascular volume leading to ADH release and therefore causing hyponatremia. In hypernatremia, it is due to loss of hypotonic fluids.
I am wondering loss of GI fluid was associated with hypernatremia if the loss is not much enough to activate the ADH release. But if severe enough loss of GI fluid would cause hyponatremia. Is it like what i said ? or anything i misunderstood. Thanks Eric!
Hello. For a patient who is taking fluid orally to correct Chronic Hypernatremia, since the recommended serum sodium concentration correction rate is 12 meq/L per day and 0.5 meq/L per hour. Does that mean the patient should not sleep while they are receiving treatment?
Is your patient taking any other food or just oral fluid?
@@manosmitanath1333 Food plus oral fluid (is it even possible for one to go for 3 days without food?)
@@stanleymakazhe593 but there's added. Salt and water in the food which makes problem in the calculations ..??
Thank you very much. You are a great instructor indeed.
excuse me sir, i have a qestion regarding the development of hypernatremia due to DM. Generally, during DM a patient usually develops hyperglycemia which leads to excessive amounts of water moving out of the ICF compartment to ECF compartment ,leading to dilutional effect on serum sodium, causing hyponatremia.Hoping for fast reply from persons who can clarify.
DM can cause both hyponatremia and hypernatremia. You described the mechanism of hypertonic hyponatremia (your ECF osmolality is severely elevated due to increased ECF glucose secondary to DM, hence the hypertonic; ECF Water>ECF sodium --> hyponatremia). For hypernatremia you end up with excessive osmotic diuresis secondary to severe glucosuria which results in free water loss with little sodium loss and in turn results in a hypovolemic hypernatremia (loss of free water = hypovolemia; ECF salt>ECF water --> Hypernatremia). If someone attempted to correct this with drinking/infusion of free water then you would end up creating a hypovolemic hyponatremia (loss of free water = hypovolemia; but now ECF water>ECF salt --> hyponatremia!). Its highly unlikely you'd be able to fully correct the water imbalance to the point of euvolemia without causing severe hyponatremia and associated symptoms. Of course all of these mechanisms can overlap and just make it that much more confusing. Just learning this now but figured this would be good practice. If anyone has any corrections please, please do so as I barely understand it myself.
Andrew Levy thank you very much sir,for spending your valuable time for explaination.😊😊👍
@@Squeek1227 Simply Amazing Explanation Bro. Thanks.
❤❤❤
Sodium 147,50 is it good
thank you so much
I nées the second video or exemple how To treat hypernatremia please.give me the link
Here you go: ruclips.net/video/Pls0fjsthlA/видео.html
Yet another excellent video, Dr Eric!
Wonderful
Hello sir. Can i ask a question sir.
Can low potassium can trigger to get a high sodium in ur body? Coz my wife when we bring him to the hospital. The first cause is her hypokalemia. Even her breathing is getting worsed. Then after a day later her body is starting to recover. Then the doctor told us that her sodium in her body is getting high its 147.00mmol/L then she sleep and her heart rate is climbing up and down. And then she passed away while sleeping.
exclusively made simple ,understandable, great lecture series and thanks
شكرا
Salty
Excelent Lecture.
👏🏽👏🏽👏🏽!!!
you are genius!!
Wonderful