REBOOT #48 Hyponatremia Deconstructed

Take your salt game to the next-next level. We brushed off this fan favorite episode and rebooted #48 hyponatremia deconstructed with our Chief of Nephrology, Dr. Joel Topf aka @kidney_boy aka The Salt Whisperer for your CME earning pleasure. Learn the correct steps to diagnose and manage this common and dangerous condition. Topics covered include: true versus false hyponatremia, SIADH, tea and toast hyponatremia, beer potomania, safe rates of sodium correction, IV fluid choice, vaptans and more. Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Original episode written and produced by: Matthew Watto MD, FACP  Show Notes and CME questions by: Deb Gorth ScM Cover Art and Infographic by: Edison Jyang Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Molly Heublein (written materials); Matthew Watto MD (audio)  Guest: Joel Topf MD Sponsors   POCUS Fellowship at University of Pennsylvania A novel, collaborative, POCUS fellowship training is available at the University of Pennsylvania for IM and FM graduates!  In 2016 they leveraged the robust EM ultrasound fellowship training infrastructure with UPenn’s progressive Department of Medicine to create the 1st multi-specialty clinical ultrasound fellowship.  Their graduating fellows have made them proud by accepting leadership positions, and if you want to be on the cutting edge, you should join their team.   Interview season is in full swing and they’re actively accepting applications.  Please go to pennultrasound.org or contact [email protected] for information.  You can apply for fellowship using the eusfellowships.com portal.   VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps 00:00 Intro 03:30 Guest interview 07:15 Pick of the week w/Dr. Topf 16:20 Clinical case of hyponatremia 17:48 False hyponatremia normal osmolality 19:34 False hyponatremia high osmolality 20:36 Understanding why osmolality matters 23:28 Workup false hyponatremia 24:45 Recap of discussion so far 25:40 ADH dependent vs independent hyponatremia 27:00 Psychogenic polydipsia 289:15 Renal failure and hyponatremia 30:03 Tea and toast, and Beer Drinker’s potomania 35:22 ADH dependent hyponatremia 38:15 Volume versus osmolality 40:00 Volume status exam 45:14 Additional testing with urine lytes and uric acid 47:30 Treatment for SIADH  52:42 Discussion of the vaptans 58:21 Additional testing in SIADH 62:50 When to admit patient for hyponatremia 63:59 Clinical case of hyponatremia complications 68:56 Fluids and rate of correction 73:36 DDAVP clamp 76:30 Moderate hyponatremia 78:35 Diuretic dosing DOES matter! 81:59 Loop diuretics for SIADH 84:25 Take home points 87:25 Outro Links* Dr. Joel Topf’s Textbook Dr. Joel Topf’s Blog Dungeons and Dragons Tartine (cookbook) by Elizabeth M. Prueitt I Hate You, Don’t Leave Me by Hall Strauss Intentional Parenting by Sissy Goff Mindset by Carol Dweck Nintendo Switch 8.0 Bit Techno- The Curbsiders Theme Song by Stuart Kent Brigham Ure-Na  European Society of Endocrinology Clinical Practice Guidelines.  Don’t miss Dr. Topf on twitter aka @kidney_boy.   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.     Goal Listeners will recall the pathophysiology of hyponatremia and develop a systematized approach to identifying the type and cause of hyponatremia, as well as how to safely manage hyponatremia.    Learning objectives After listening to this episode listeners will…   Differentiate true and false hyponatremia Recall the pathophysiology of true and false hyponatremia  Interpret blood and urine tests to identify the cause of hyponatremia Recall the limitations of the volume status exam List ADH dependent causes of hyponatremia List ADH independent causes of hyponatremia  Explain the pathophysiology of beer drinker’s potomania and “tea and toast” hyponatremia Use uric acid to differentiate SIADH from other causes of hyponatremia Basic therapy for SIADH Recall safe rates of correction for hyponatremia   Disclosures Dr. Topf has received honoraria from AstraZeneca and Cara Therapeutics. He is joint venture partner in Davita Dialysis centers receiving dividends. The Curbsiders report no relevant financial disclosures.    Citation Topf J, Gorth DJ, Williams PN, Brigham SK, Heublein M, Jyang E, Watto MF. “REBOOT #48 Hyponatremia Deconstructed”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Original air date: July 17, 2017; Updated September 7, 2020.