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Internal Medicine Meeting Nephrology Journal Club

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Internal Medicine Meeting Nephrology Journal Club Staci Smith DO Sarah K. Sundet, DO MBA October 28, 2009 Focus on Hyponatremia and Vasopressin Receptor Antagonists ... – PowerPoint PPT presentation

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Title: Internal Medicine Meeting Nephrology Journal Club


1
Internal Medicine Meeting Nephrology Journal Club
  • Staci Smith DO
  • Sarah K. Sundet, DO MBA
  • October 28, 2009

2
Focus on Hyponatremia and Vasopressin Receptor
Antagonists
  • Hyponatremia
  • Defined as a serum sodium less than 135
  • Often overlooked and undertreated
  • Most common electrolyte disturbance
  • Age is a risk factor age 51-60 yo equals 2x
    higher and greater than 70 yo is 3x higher
  • Independent risk factor of death in ICU and
    geriatric pts with CHF, STEMI, and cirrhosis

3
Focus on Hyponatremia
  • Timing and onset
  • If less than 48 hrs, defined as acute
    hyponatremia
  • More severe symptoms because the brain cant
    adapt causing cerebral edema
  • Water shifts from hypotonic ECF to intracellular
    space
  • If greater than 48 hrs, chronic hyponatremia

4
Focus on Hyponatremia
  • Management of hyponatremia
  • Historically, sodium replacement, free water
    restriction, and loop diuretics were only options
  • Challenging multistep process by appropriate rate
    of correction and multiple labs
  • Often hard to accept for patients

5
Focus on Hyponatremia
  • Classified based on history and physical exam
  • Hypovolemic hyponatremia
  • Vomiting,diuretics,diarrhea, excessive sweating
  • Vasopressin is secreted to defend against volume
    contraction, which enhances water reabsoption
  • Normovolemic hyponatremia
  • SIADH most commonly
  • Adrenal insufficiency
  • Hypothyroidism
  • Hypervolemic hyponatremia
  • CHF, liver cirrhosis, nephrotic syndrome
  • Excessive RAA and vasopressin release

6
Focus on Hyponatremia
  • Previous therapies do not involve underlying
    etiology, excessive secretion of vasopressin

7
Vasopressin Two principal sites of action
  • AVP has two principal sites of action
  • the kidney
  • increases water reabsorption in the kidneys by
    increasing water permeability in the collecting
    duct, thereby permitting the formation of a more
    concentrated urine
  • This is the antidiuretic effect of AVP and it
    acts through vasopressin type 2 (V2) receptors
    coupled to adenylyl cyclase
  • The blood vessels
  • constricts arterial blood vessels by binding to
    V1 receptors
  • compensatory increase in systemic vascular
    resistance

8
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