11. Ideal weight : Females: 45 kg Males: 50 kg Adjusted weight : ideal weight + 0.4 (actual body weight – ideal weight) + 2.3 kg for every inch over 5 feet
56. The response to hyponatremia Low sodium concentration causes water to move into the cells. In the brain this causes an increase in ICP. Compensated chronic hyponatremia is essentially asymptomatic.
57. The problem with compensation The starting point is after compensation has reduced the amount of intracellular solute and the ICP Now, an over-eager intern sees the low sodium and starts an infusion of 3% NaCl to raise the sodium to normal. Sodium 108 The sodium draws water from the inside of the cells causing the brain to shrivel. The problem with interns This causes osmotic brain damage. Central pontine myelinolysis. This is lethal. Sodium 134
69. 9% of patients had overly rapid (>12 mmol/L in 24 hours) correction of hyponatremia Potent CYP3A4 inhibitor: Caution with ketoconazole, itraconazole, clarithromycin, ritonavir and indinavir Placebo (n=21) Conivaptan 40mg/d (n=18) Baseline sodium 124.3 mmol/l 123.6 mmol/l Sodium at 48 hours 125.1 mmol/l 129.4 mmol/l Sodium at 96 hours 126.7 mmol/l 130.0 mmol/l Number with a Na rise of ≥ 6 mmol/L at 48 hours 0 (0%) 7 (38.9%) Number with a Na rise of ≥ 6 mmol/L at 96 hours 6 (28.6%) 12 (66.7%)
81. 100 kg 70 kg Ideal weight : Females: 45 kg Males: 50 kg Adjusted weight : ideal weight + 0.4 (actual body weight – ideal weight) + 2.3 kg for every inch over 5 feet 60% H 2 O 45% H 2 O
Homer Smith is one of the pre-eminant evolutionary biologists of the 20th century. He did comparative biology on the kidney and elucidated much of basic renal physiology
So a passing interest is more than just a good idea it is essential
Matt Carrington Jennifer Strange Walter Dean Jennings III