recurrent hyponatremia

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Dr. Simcha Shapiro

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Oct 17, 2013, 1:37:35 AM10/17/13
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Dear colleagues,
  I presently have 2 patients who are suffering with recurrent hyponatremia, neither of whom are taking diuretics.  3G of sodium/day has not successfully kept the sodium up.  Does anyone have any ideas that will allow me to keep these folks out of the hospital?


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Dr. Simcha Shapiro
Leumit Family Physician
Sabar Home Hospice Care
Jerusalem, Israel

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Oct 17, 2013, 3:19:46 AM10/17/13
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What's the clinical/symptomatic presentation of their hyponatremia? And how are they treated in the hospital?

Dr Ron Sabar
Sabar Clinics and Hospice

‫ב-17 באוק 2013, בשעה 08:37, ‏"Dr. Simcha Shapiro" <drsi...@gmail.com> כתב/ה:‬

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פאליאטיב ישראל, הינו הפורום לאנשי מקצוע ברפואה הפליאטיבית. מטרת הפורום- שיתוף ידע, יצירת קהילה מקצועית וקידום הרפואה הפליאטיבית בישראל.
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Dr. Simcha Shapiro

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Oct 17, 2013, 4:46:33 AM10/17/13
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They presented with confusion and agitation along with swelling in their legs  When treated with IV fluids, they normalized.  I need to watch for fluid overload, and am not sure if SC fluids will be as effective.  Any thoughts?

glynis katz

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Oct 17, 2013, 6:39:48 AM10/17/13
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glynis katz

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Oct 17, 2013, 6:47:57 AM10/17/13
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Some thoughts:
What about giving saline sc and adding a small dose of aldactone
Or drinking dioralite with fluid restriction or
fluid restriction 500 daily

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Oct 17, 2013, 7:54:06 AM10/17/13
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מסכים לגמרי 

Dr Ron Sabar
Sabar Clinics and Hospice

‫ב-17 באוק 2013, בשעה 13:47, ‏glynis katz <glyni...@gmail.com> כתב/ה:‬

eyal goldberger

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Oct 17, 2013, 10:10:08 AM10/17/13
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Shalom,

I miss some details . Before treating the symptom we should try to arrive and treat the underlying diagnosis: Paraneoplastic Synd, with SIADH (usually without edema). (renal function, urine and serum electrolytes) , other drugs beside diuretic such as SSRI, Phenothiazine, NSAID, chemotherapy, and even narcotics etc., RF,CHF?

For SIADH whenwe might also can think about :

Demeclocycline

It is widely used (though off-label in many countries) in the treatment of hyponatremia  due to the syndrome of inappropriate antidiuretic hormone (SIADH) when fluid restriction alone has been ineffective.[3] Physiologically, this works by reducing the responsiveness of the collecting tubule cells to ADH.

The use in SIADH actually relies on a side effect; demeclocycline induces nephrogenic diabetes insipidus

 (dehydration due to the inability to concentrate urine).[3] The use of demeclocycline in SIADH was first reported in 1975,[4] and, in 1978, a larger study found it to be more effective and better tolerated than lithium carbonate, the only available treatment at the time.[5] Demeclocycline has since been the drug of choice for treating SIADH,

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Dr. Simcha Shapiro

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Oct 18, 2013, 3:14:41 AM10/18/13
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Thanks to everyone who replied.  I will let you know how it turns out.
Shabbat Shalom.

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פאליאטיב ישראל, הינו הפורום לאנשי מקצוע ברפואה הפליאטיבית. מטרת הפורום- שיתוף ידע, יצירת קהילה מקצועית וקידום הרפואה הפליאטיבית בישראל.
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