Sodium correction

General surgery ppt - PG

1. Disorders of sodium ion in Surgical practice

2. Distribution of Sodium Ion

3. Regulation of Excretion of Sodium

4. 99% of filtered Na is reabsorbed Na is the most abundant cation in ECF. Accounts for 90% of osmotic activity in plasma and ISF. Urinary output range from 1 mEq /day on low salt diet to 400 mEq /day in high salt diet.

5. Hyponatraemia Sodium - < 130 meq /l Mild : 130 to 138 Moderate : 120 to 130 Severe :<120 Severe Acute : <100 meq /l Chronic : <115meq/l Types I Acute: Chronic II Hypervolaemic hyponatremia Hypovolemic hyponatremia Normovolemic hyponatremia Pseudo hyponatremia

6. Hypervolaemic hyponatremia : Absorption of fluid into intravascular compartment. Severe : S Na< 100 mmol /l Urine sodium will be , 15 mmol /l Corrected with hypertonic saline. Slow correction: 2meq/hr Q4hrly serum sodium measurement

7. Hypovolemic hyponatremia : Due to: Diarrhoea & vomiting – urine sodium < 20mmoles/l Renal causes - urine sodium > 20 mmoles /L Shock Correction with isotonic normal saline.

8. Normovolemic Hyponatraemia Renal failure SIADH Treatment: Fluid restriction. Demeclocycline – vasopressin anagonist Pseudohyponatremia Due to increase in other solutes like glucose,lipids,plasma protien,urea .

9. Causes of hyponatraemia : Intestinal obstruction Intestinal fistulas Gastric outlet obstruction with vomiting Severe diarrhoea SIADH Immediately after surgery or trauma Stroke Cerebral salt-wasting syndrome (CSWS) is a rare endocrine condition featuring a low serum Na concentration and dehydration in response to trauma/injury.

10. Clinical features of hyponatraemia : Dry coated tongue Sunken eyes Dry wrinkled skin Hypotension Dark scanty urine Irritability, disorientation. Convulsions Chronic hyponatraemia : Hypothermia, reduced tendon reflex , pseudo bulbar palsy.

11. Serum electrolyte. Urine sodium. Sodium deficit : (125 – present S.sodium ) x body weight(kg) x 0.6 Management: Acute : Rate 2meq/L/hr Not more than 10meq /Day Chronic : Rate < 1 meq /L/hr Not more than 10 meq /L/day Management

12. Hypernatraemia Serum sodium : > 150 meq /L. Causes: Normal saline overload Renal dysfunction Cardiac failure Drug induced: NSAIDS,Corticosteroids

13. Clinical features Pitting oedema Puffiness of face Increased urination Dilated jugular veins Pulmonary oedema features .

14. Types of Hypernatraemia Euvolemic : Failure of water intake – in comatous patient,bedridden , postoperative,high fever patient. Diabetes insipidus Chronic renal failure. Hypovolemic : More water loss than sodium Vomiting Diarrhoea Undue sweating Osmotic diuresis – glucose/ mannitol . Hypervolemic : Salt intake Hypertonic saline infusion.

15. Treatment Restriction of sodium. Slow correction : Dextrose 5% Fast correction can cause cerebral oedema Oral / NG administration of water.

16. 5 percent dextrose in water, intravenously, at a rate of 3 to 6  mL /kg per hour . The serum sodium and blood glucose should be monitored every one to two hours until the serum sodium is lowered below 145  meq /L . •Once the serum sodium concentration has reached 145  meq /L, the rate of infusion is reduced to 1  mL /kg/hour and continued until normonatremia (140  meq /L) is restored . •The goal of this regimen is to lower the serum sodium by 1 to 2  meq /L per hour and to restore normonatremia in less than 24 hours . Free water deficit correction.

17. Thank you !!!