Central diabetes insipidus
Nephrogenic diabetes insipidus
Half-normal saline (0.45% saline)
Syndrome of inappropriate antidiuretic hormone
Table 13.1.1 Fluid Composition and Uses |Favorite Table|Download (.pdf)
Table 13.1.1 Fluid Composition and Uses
May impair glucose control in diabetes; provides free water to all compartments
- Maintenance dosing according to the 4:2:1 rule:
- 4 mL/kg/hr for 1–10 kg
- Add 2 mL/kg/h for 10–20 kg
- Add 1 mL/kg/h for every kg over 20 kg
½ NS—0.45% NaCl
(Na+ 77 mEq/L, Cl− 77 mEq/L)
Hyponatremia with long-term use; increased risk of IV infiltration vs. isotonic
(Na+ 154 mEq/L; Cl− 154 mEq/L)
Fluid replacement; hypovolemia, shock
Monitor for fluid overload; hyperchloremic metabolic acidosis with large volumes
- Dose varies widely depending on patient fluid status and clinical situation
(Na+ 130 mEq/L, Cl− 109 mEq/L
Lactate 28 mEq/L, K+ 4 mEq/L
Ca++ 3 mEq/L)
Fluid replacement; hypovolemia
Lactate converted to bicarbonate in the liver, may accumulate in cirrhosis leading to lactic acidosis
(Na+ 513 mEq/L, Cl− 513 mEq/L)
Severe symptomatic hyponatremia
Osmotic demyelination syndrome with too-rapid correction (>12 mEq/L/d for acute hyponatremia, >8 mEq/L/d for chronic hyponatremia)
- Initial rate = desired serum [Na+] increase per hour (mEq/h) × patient weight (kg) (example: ↑ Na+ by 1 mEq/L/h in 70 kg patient = 70 mL/h infusion, Am J Med. 2007;120(11A):S1)
- Alternate calculation: Effect of 1 L 3% saline on serum [Na+] = (513 – serum Na+)/(TBW+1), where TBW = 0.6 × weight (kg) for males, 0.5 × weight (kg) for females, rate to raise 1 mEq/L/hr = 1/(Effect of 1 L 3% saline on serum [Na+])
Figure 13.1.2 Evaluation Algorithm for Hyponatremia
Figure 13.1.3 Treatment Algorithm for Hyponatremia
Figure 13.1.4 Assessment and Treatment Algorithm of Hypernatremia
aTBW = 0.5 × weight (kg) females: 0.6 × weight (kg) males.
Table 13.1.5 Pharmacotherapy of Sodium Disorders |Favorite Table|Download (.pdf)
Table 13.1.5 Pharmacotherapy of Sodium Disorders
Acute hyponatremia with severe symptoms
Infusion rate = desired [Na+] ↑ per hour (mEq/h) × weight (kg) (see Table 13.1.1)
- Limit serum [Na+] correction ...
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