This is the reason I watch your teaching, you really teach the importance stuff, I am so glad to get ALL MY ANSWERS from your videos. God bless you for teaching and sharing ❤❤❤❤❤
Dr Liu. Thank you. Now I understand. I loved it. Please, could you add a two-question quiz at the end or present a case at the beginning to solve at the end to assess or check understanding?
Thank you Dr. Liu. Your explanation of hyponatremia is really helpful. I am not a doctor, but this helps me understand why MD orders certain kind of tx for pt.
This is incredible Dr Suppy, thank you so much! Just in time for my Step 3. You made this topic so much easier to understand, thank you! P.s. I play Zerg because of you! (And Nestea, my two favorite players back in the day)
Do you check serum osmolality or tonicity? In other words, do you include BUN in the formula or not? In most patients, it won’t matter, but in patients with azotemia, it can make the difference between classifying a case as hypotonic or isotonic.
Hi Conan, thanks for the informative video. I am currently studying on this topic and i found that GI loss ( diarrhea, vomiting...) was listed in both hypernatremia and hyponatremia. Here's my thought 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 Conan!
Hi kaze, very interesting points! I like your thought process a lot. I’m not 100% sure on this answer, but to be honest I feel that most of the time (in my experience at least), hypernatremia is almost always an *intake* problem. For example, elderly patients who can’t move well to get water or communicate their thirst drive is the classic example. For these patients it’s an issue of lack of free water intake which leads to hypernatremia. On the other hand, diarrhea and vomiting more typically cause hyponatremia due to the mechanisms you laid out so nicely!
Is it possible to get this condition by drinking too much fresh water? How much relative to the body weight would that be? Old wives tales often sugged not drinking too fast after thirst. But I have experienced no effect.
Yes you can get dangerously low sodium from drinking too much! It has to be a LOT of fluids but it is possible, and there have been several cases of death from college hazing events in which they force people to drink excessive amounts of fluids! Drinking too quickly usually isn't a problem as long as the overall amount isn't too excessive
He didn’t mention in his video but if you look at the algorithm at 7:16. We check vital sign, skin turgor, jvp, mucous membranes, peripheral edema, bun, Uric acid levels, orthostatic BP
I have an elderly at home who was diagnosed with chronic hyponatremia. We didn't know he had very low sodium levels. The first time it was flagged was when he suffered a seizure that lasted for about 30 seconds. I thought he had a stroke or a heart attack. At the hospital, his ECG was fine. Low blood pressure. They did CT scan, nothing wrong with the brain. But blood chemistry showed very low sodium levels. He was alcoholic. From that day on, he often has very low blood pressure in the morning 87/56, sodium is always very low. What i do to correct the problem at home is to have him drink a glass of non-sugar Gatorade every few hours. His blood pressure normalized the whole day, and his cognitive impairment improved. Sometimes, i have him take a Nutricost electrolyte capsule instead of Gatorade. I also have him take Cordyceps 1,000 mg twice a day to improve kidney function.
This is the reason I watch your teaching, you really teach the importance stuff, I am so glad to get ALL MY ANSWERS from your videos.
God bless you for teaching and sharing ❤❤❤❤❤
Dr Liu. Thank you. Now I understand. I loved it. Please, could you add a two-question quiz at the end or present a case at the beginning to solve at the end to assess or check understanding?
M4 about to start residency and the number of times I've had to look this algorithm up D: thank you for this!!
Super helpful!! Thank you so much! I’ve been struggling with it for a while.
Thank you Dr. Liu. Your explanation of hyponatremia is really helpful. I am not a doctor, but this helps me understand why MD orders certain kind of tx for pt.
😊😊
😊😊
This is incredible Dr Suppy, thank you so much! Just in time for my Step 3. You made this topic so much easier to understand, thank you!
P.s. I play Zerg because of you! (And Nestea, my two favorite players back in the day)
Bahahaha very nice!!! :) Zerg will always be the best. Thank you for your comment and GL with Step 3!!
absolutely amazing video! best on youtube for this topic!
Thank u dr. Liu you are a great educator
Brilliant! Please do one for hypo/hyperkalemia
Thank you for this video It was really helpful
Excellent video!!! Thank you for your hard work!!
Great review. I do my best to initiate the work up for the folks upstairs.
Do you check serum osmolality or tonicity? In other words, do you include BUN in the formula or not? In most patients, it won’t matter, but in patients with azotemia, it can make the difference between classifying a case as hypotonic or isotonic.
Thank you Dr. ❤
Super helpful!! 😊
Best explanation
Do they ever give albumin in hypovolemic hyponatremia with 3rd spacing?
love your video. awaiting hypernatremia
Excellent! Thank you.
I have always difficulty assesing the volume status. What parameters do you use?
Thank you for the very helpful video. When would you use salt tabs in the management in hyponatremia?
It can be a treatment for SIADH! It helps increase free water excretion. Sometimes urea tabs work better though
@@ConanLiuMD Thank you!
Hi Conan, thanks for the informative video. I am currently studying on this topic and i found that
GI loss ( diarrhea, vomiting...) was listed in both hypernatremia and hyponatremia. Here's my thought
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 Conan!
Hi kaze, very interesting points! I like your thought process a lot. I’m not 100% sure on this answer, but to be honest I feel that most of the time (in my experience at least), hypernatremia is almost always an *intake* problem. For example, elderly patients who can’t move well to get water or communicate their thirst drive is the classic example. For these patients it’s an issue of lack of free water intake which leads to hypernatremia. On the other hand, diarrhea and vomiting more typically cause hyponatremia due to the mechanisms you laid out so nicely!
Is it possible to get this condition by drinking too much fresh water? How much relative to the body weight would that be? Old wives tales often sugged not drinking too fast after thirst. But I have experienced no effect.
Yes you can get dangerously low sodium from drinking too much! It has to be a LOT of fluids but it is possible, and there have been several cases of death from college hazing events in which they force people to drink excessive amounts of fluids! Drinking too quickly usually isn't a problem as long as the overall amount isn't too excessive
How do you assess volume status
He didn’t mention in his video but if you look at the algorithm at 7:16. We check vital sign, skin turgor, jvp, mucous membranes, peripheral edema, bun, Uric acid levels, orthostatic BP
Thanks! I was listening while driving so I actually didn’t see the visual lol
Excellent 👍
I have an elderly at home who was diagnosed with chronic hyponatremia. We didn't know he had very low sodium levels. The first time it was flagged was when he suffered a seizure that lasted for about 30 seconds. I thought he had a stroke or a heart attack. At the hospital, his ECG was fine. Low blood pressure. They did CT scan, nothing wrong with the brain. But blood chemistry showed very low sodium levels. He was alcoholic.
From that day on, he often has very low blood pressure in the morning 87/56, sodium is always very low.
What i do to correct the problem at home is to have him drink a glass of non-sugar Gatorade every few hours. His blood pressure normalized the whole day, and his cognitive impairment improved. Sometimes, i have him take a Nutricost electrolyte capsule instead of Gatorade.
I also have him take Cordyceps 1,000 mg twice a day to improve kidney function.
amazing
You are hyponatremia God #MS3student
You talk too fast.
Thank you for the feedback
@@ConanLiuMDI just got out of the hospital for low sodium level, they got it up to 233, what's the best way to keep it up?
Hypo - meaning presence in blood!
That's not true
Hypo means literally "under" and it means low. Hypothyroid means the thyroid is under working.