Severe HypoNatremia management - ✔️✔️1. Only hypotonic hyponatremia requires
treatment directed at sodium.
2. (<120 mEq/L): infuse 3% hypertonic saline to increase Na by 1-2/hr until rises by 4-
6mEq/L
3. Max correction: 8-12 mEq/L per 24hr period or 25 mEq/L per 48hrs.
4. Restrict fluids to 1000ml/24hrs except in hypovolemic
Serum osmolality equation - ✔️✔️1. (2 x Na) + BUN /2.8 + Glucose /18
2. When glucose and BUN are normal : 2 x Na
Serum Sodium (normal range) - ✔️✔️135-145 mEq/L
Sodium replacement formula - ✔️✔️1. (0.5 or 0.6 x kg) x (desired Na - serum Na) =
mEq Na over 4 hrs
2. Need/Have mEq Na x 1 liter = L/4hrs = ml/hr
3. Maximum correction rate is 8-12 mEq/L/24 hr. OR 25 mEq/L/48 hr.
Total Body Water (TBW) formula - ✔️✔️50% of body weight in women; 60% in men
Phosphorus (normal range) - ✔️✔️2.5-4.5 mg/dL
Potassium (normal range) - ✔️✔️3.5-5.0 mEq/L
Magnesium (normal range) - ✔️✔️1.5-2.5 mg/dL
, Moderate HypoNatremia Management - ✔️✔️1. Only hypotonic hyponatremia requires
treatment directed at sodium.
2. (120-129 mEq/L): infuse 3% hypertonic saline
3. Restrict fluids to 1000ml/24hrs except in hypovolemic
Mild HypoNatremia Management - ✔️✔️1. Only hypotonic hyponatremia requires
treatment directed at sodium.
2. (130-134 mEq/L): infuse 0.9% saline to correct
3. Restrict fluids to 1000ml/24hrs except in hypovolemic
HyperNatremia Management - ✔️✔️1. >145 mEq/L
2.Correct 1-2 mEq/L to avoid cerebral edema.
3.D/c or reduce saline administration.
4. Increase oral water intake.
5.Mild volume depletion: D5%W
6. Moderate volume depletion: 0.45% NS
7. Severe volume depletion: 0.9% NS; follow with 0.45%NS or D5W when cardio status
stabilized.
FENa - ✔️✔️1. Fractional Excretion of sodium in urine
2. Decrease--> increased renal reabsorption
3. Increase--> renal wasting from ATN
4. Formula: 100 x [Na (urine) x Creatinine (plasma) /
Na (plasma) x Creatinine (urine)]
HypoCalcium Management, Symptomatic - ✔️✔️1. Acute
2. Calcium chloride 1gm 10% IV over 3-5 mins
3. Calcium gluconate 1gm 10% IV over 3-5 mins x 2 doses
HyperCalcium Management, Severe - ✔️✔️1. Malignancy
2. 0.9%NS to restore volume
3. Calcitonin 4-8 IU/kg Q12hrs SQ/IV
4. Bisphosphonates (treatment of choice)
5. Lasix 40-80mg IV Q8-12hrs to maintain urine output 150-200ml/hr
6. HD with low-calcium dialysis bath
HyperCalcium Management, Chronic - ✔️✔️1. Granulomatosis disease: need consult
2. Reduced calcium diet to 750-1000mg/day
HypoPhosphatemia Management - ✔️✔️1. Oral: tablets of sodium or potassium neutral
phosphorus (Neutra phos/ K-Phos neutral) 0.5-1gm PO daily
2. IV: solution of sodium or potassium phosphate 9-10mmol/2 hrs
HyperPhosphatemia Management - ✔️✔️1. Dialysis in acute or chronic renal failure.
2. Dietary restriction on phosphorus (800-1000mg/day)
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