Kambiz: Chronic cases of hypo hypernatremia. We usually send the blood sample to [xx] to measure serum osmolality, and we calculate the difference between the measured and the calculated serum osmolality mainly to see if there is a difference which is usually greater than nine. We call it a small gap that suggests something other than urea, nitrogen glucose, or sodium is contributing to serum osmolality. And this is usually an intoxication with alcohols and infusion of high plasma osmolality [?]
So let's talk about hypernatremia first. I just want to emphasize that you have had hydra renal physiology [?] in week one and you heard about all the normal physiology of water and sodium and potassium. So to clinically approach hypernatremia, you …show more content…
This is called dilution hyponatremia. And also, other possibility is that we have too much ADH around and this ADH is causing increased absorption of water and hyponatremia, which is actually the most common reason we get hyponatremia.
So the first thing to deal with is is it real or super hyponatremia? It's very rare to see this. You probably will never see in clinical practice, but sometimes you may get bond [xx] even not that.
It only occurs in cases with severe hyperlipidemia and severe hyperproteinemia. The reason for that is that usually plasma is made of lipids proteins, 7% of it, and water which is 93% of it. So if we consider sodium in a plasma sodium of about 140 mmol per liter, if you want to calculate the concentration of sodium and plasma water since 93% of it is water, if you divide 140 by 0.93, plasma water sodium would be 153 mmol per liter of plasma water. But now in a situation when you have hyperproteinemia or hyperlipidemia if that water portion drops from 93% to 80% that means now that... At the same time you plasma water sodium remains the same at 153, now the lab reports a value of 122.4 for you, and that's why it's pseudo hyperproteinemia because sodium concentration hasn't changed and the old reason that you get hyponatremia reported to you by the lab is because of high concentration of lipids and protein in the blood. And these cases serum osmolality [xx]
So let's talk about hypernatremia first. I just want to emphasize that you have had hydra renal physiology [?] in week one and you heard about all the normal physiology of water and sodium and potassium. So to clinically approach hypernatremia, you …show more content…
This is called dilution hyponatremia. And also, other possibility is that we have too much ADH around and this ADH is causing increased absorption of water and hyponatremia, which is actually the most common reason we get hyponatremia.
So the first thing to deal with is is it real or super hyponatremia? It's very rare to see this. You probably will never see in clinical practice, but sometimes you may get bond [xx] even not that.
It only occurs in cases with severe hyperlipidemia and severe hyperproteinemia. The reason for that is that usually plasma is made of lipids proteins, 7% of it, and water which is 93% of it. So if we consider sodium in a plasma sodium of about 140 mmol per liter, if you want to calculate the concentration of sodium and plasma water since 93% of it is water, if you divide 140 by 0.93, plasma water sodium would be 153 mmol per liter of plasma water. But now in a situation when you have hyperproteinemia or hyperlipidemia if that water portion drops from 93% to 80% that means now that... At the same time you plasma water sodium remains the same at 153, now the lab reports a value of 122.4 for you, and that's why it's pseudo hyperproteinemia because sodium concentration hasn't changed and the old reason that you get hyponatremia reported to you by the lab is because of high concentration of lipids and protein in the blood. And these cases serum osmolality [xx]