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Metabolic Laboratory Data
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Serum sodium levels are really an interaction between sodium and water. This means that hypernatremia is generally too little circulating water rather than too much sodium. The opposite is also true. Hyponatremia is too much water much more often than too little sodium.
Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Phosphate enemas contain sodium acid phosphate and sodium phosphate, which have an osmotic effect resulting in increased stool water. They usually induce defaecation within ten minutes of administration, but there is no robust clinical trial evidence of efficacy in the treatment of constipation.22 They have, rarely, been associated with significant adverse effects. These include hyperphosphataemia and hypernatraemia, which appear to be more likely in patients with either renal impairment or significant dehydration. Adverse events are also more common in older people.23 They have been associated with rectal bleeding and perforation and should be avoided in people with rectal or anal disease. People who are subsequently incontinent are at risk of skin lesions from the solution. Given the potential harms, they should be used with caution.
Severe Electrolyte Disturbances
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Melanie P. Hoenig, Jeffrey H. William
Hypernatremia may be caused by water loss or sodium gain. Water loss can develop from gastrointestinal losses from emesis, diarrhea, or surgical drainage of gastrointestinal fluids. Urinary losses can occur either from a solute diuresis induced by mannitol, a high protein diet or hyperglycemia, or from a water diuresis as observed with diabetes insipidus. Water losses from skin as with sweat with fever or loss of the skin barrier function from severe burns may also cause hypernatremia. Sodium gain is a less common cause of hypernatremia, particularly prior to hospital admission but has been described with ingestions of seawater in near drowning, gargling, or dangerous behaviors such as soy sauce or pickle juice ingestion. During hospitalization, sodium gain can occur with the use of hypertonic fluids such as repeated administration of intravenous sodium bicarbonate ampules.
Where there is sodium there may be sepsis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Gerson De Freitas, Anuragh Gudur, Myriam Vela-Ortiz, Jacek Jodelka, David Livert, Mahesh Krishnamurthy
Sodium concentration is the major determinant of the extracellular fluid volume in the body, and it is normally maintained within a narrow physiologic range despite large variations in daily sodium and water intake. Hypernatremia – defined as serum sodium greater than 145mEq/L – is a condition that is commonly observed in patients upon hospital admission, affecting up to 9% of critically ill patients in some hospitals [1–5]. Higher levels of sodium can be associated with a wide range of clinical features which are generally the result of neurological dysfunction due to brain cell shrinkage. Some of these major features include confusion or seizures [6]. Moreover, the mortality rate of patients with hypernatremia is significantly higher than that of patients not affected by this condition [1–5].
Lipid emulsion for acute organophosphate insecticide poisoning – a pilot observational safety study
Published in Clinical Toxicology, 2019
Bharath A. Chhabria, Ashish Bhalla, Nusrat Shafiq, Susheel Kumar, Deba Prasad Dhibar, Navneet Sharma
Hemoglobin, total leukocyte count, thrombocyte count, serum sodium, potassium, and renal functions were tested prior to lipid emulsion, 24 and 72 h following administration of lipid emulsion in the study group. No significant difference was noted in these parameters. Hypernatremia (serum sodium >145 meq/L) was seen in 13 patients (32.5%) in the study group and progressive decline was noted with 11 patients (27.5%) and 5 patients (12.5%) continued to have hypernatremia after 24 and 72 h, respectively (Table 3). Serum amylase levels were elevated in15 patients (37.5%) in the study group. However, progressive decline was noted with only 9 (20.2%) patients and 4 (10%) patients continuing to have hyperamylasemia at 24 and 72 h, respectively. None of the patients in the study group demonstrated rise in serum amylase at 24 h or 72 h after lipid emulsion therapy. Abdominal pain suggestive of acute pancreatitis was not seen in any patient following therapy with lipid emulsion.
Cardiac arrhythmias, electrolyte abnormalities and serum cardiac glycoside concentrations in yellow oleander (Cascabela thevetia) poisoning – a prospective study
Published in Clinical Toxicology, 2019
Anandhi D., Vinay R. Pandit, Tamilarasu Kadhiravan, Soundaravally R., K. N. J. Prakash Raju
Serum creatinine was elevated (>1.2 mg/dl) in 22 (11.5%) patients; among them, 5 had hypotension at admission and 2 had chronic kidney disease. The mean serum sodium was 141.9 ± 6.5 mEq/L. Seventeen (9%) patients had hyponatremia (serum sodium <135 mEq/L) and 41 (21%) had hypernatremia (serum sodium >145 mEq/L). The mean serum potassium was 4.7 ± 0.9 mEq/L. Five (3%) patients had hypokalemia (potassium <3.5 mEq/L) with the lowest value being 3.2 mEq/L, whereas 45 (25%) patients had hyperkalemia (potassium >5.0 mEq/L) with the highest value being 10.4 mEq/L. The mean serum total calcium level was 9.6 ± 1.2 mg/dL (2.4 ± 0.3 mmol/L). Five patients had hypocalcemia with values below 8.5 mg/dL (<2.1 mmol/L). The mean serum magnesium level was 2.04 ± 0.32 mg/dL (0.84 ± 0.13 mmol/L). Two patients had hypomagnesemia with values below 1.3 mg/dL (<0.5 mmol/L). The mean serum cardiac glycoside concentration at presentation was 2.36 ± 1.17 ng/ml (3.02 ± 1.5 nmol/L). Serial estimation of cardiac glycoside concentrations was done in 43 patients who presented within 24 hours of consuming atleast five seeds. The mean serum concentration was observed to decline gradually over days (Figure 2). Error bars in Figure 2 represent standard deviation. There was a difference in number of patients tested everyday either because the patients were discharged as they improved clinically, or because the blood samples became hemolysed.