17. Hyponatremia in Critical Illness with Dr Joel Topf

In this episode of Critical Care Time, Dr. Cyrus Askin and Dr. Nick Mark are joined by Dr. Joel Topf (aka @KidneyBoy) to discuss hyponatremia, a common and potentially serious problem in critically ill patients. They discuss the definition, common etiologies, and complexities of hyponatremia, emphasizing the importance of considering tonicity versus osmolality. The panel explores the challenges of diagnosis and management, including the controversy around correction rates and the risk of osmotic demyelination syndrome (ODS). Dr. Topf introduces the DDAVP clamp as a proactive strategy to prevent overcorrection in high-risk patients, and the group also touches on the interplay between potassium and sodium levels, as well as special considerations for acute versus chronic hyponatremia.

Outlines

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Critical Care Time

Introduction to Sodium Imbalance and Humility in Medicine

Introduction to Hyponatremia and a Clinical Case

The Complexity of Hyponatremia and Oversimplification

Tonicity vs. Osmolality and the Importance of Clinical Context

Disposition of Hyponatremic Patients and Avoiding Iatrogenic Injury

A Framework for Approaching Hyponatremia: ADH and Neurohormonal States

Initial Management Steps and Pseudo-Hyponatremia

The Controversy of Correcting Hyponatremia: How Fast is Too Fast?

Risk Factors for ODS and the Role of Potassium

The Edelman Formula and Treating Seizures Due to Hyponatremia

The DDAVP Clamp: A Proactive Strategy for Preventing Overcorrection

Cost-Effectiveness of DDAVP and the Use of Tolvaptan

Chronic Hyponatremia and Closing Thoughts

Plugs, Thanks, and Disclaimers

17. Hyponatremia in Critical Illness with Dr Joel Topf

Critical Care Time

00:00Introduction to Sodium Imbalance and Humility in Medicine

Introduction to Sodium Imbalance and Humility in Medicine

00:55Introduction to Hyponatremia and a Clinical Case

Introduction to Hyponatremia and a Clinical Case

04:30The Complexity of Hyponatremia and Oversimplification

The Complexity of Hyponatremia and Oversimplification

09:19Tonicity vs. Osmolality and the Importance of Clinical Context

Tonicity vs. Osmolality and the Importance of Clinical Context

14:57Disposition of Hyponatremic Patients and Avoiding Iatrogenic Injury

Disposition of Hyponatremic Patients and Avoiding Iatrogenic Injury

18:31A Framework for Approaching Hyponatremia: ADH and Neurohormonal States

A Framework for Approaching Hyponatremia: ADH and Neurohormonal States

23:36Initial Management Steps and Pseudo-Hyponatremia

Initial Management Steps and Pseudo-Hyponatremia

27:48The Controversy of Correcting Hyponatremia: How Fast is Too Fast?

The Controversy of Correcting Hyponatremia: How Fast is Too Fast?

37:00Risk Factors for ODS and the Role of Potassium

Risk Factors for ODS and the Role of Potassium

42:02The Edelman Formula and Treating Seizures Due to Hyponatremia

The Edelman Formula and Treating Seizures Due to Hyponatremia

48:45The DDAVP Clamp: A Proactive Strategy for Preventing Overcorrection

The DDAVP Clamp: A Proactive Strategy for Preventing Overcorrection

55:01Cost-Effectiveness of DDAVP and the Use of Tolvaptan

Cost-Effectiveness of DDAVP and the Use of Tolvaptan

1:02:07Chronic Hyponatremia and Closing Thoughts

Chronic Hyponatremia and Closing Thoughts

1:05:41Plugs, Thanks, and Disclaimers

Plugs, Thanks, and Disclaimers