Manejo de la hiponatremia: proveyendo tratamiento y evitando daño

Manejo de la hiponatremia: proveyendo tratamiento y evitando daño Management of hyponatremia: providing treatment and avoiding harm. Vaidya C, Ho W, Freda BJ. Tufts University School of Medicine, Renal Division, Baystate Medical Center, MA, USA. Cleve Clin J Med. 2010 Oct;77(10):715-26. Abstract Hyponatremia, in its most severe form, requires urgent infusion of hypertonic saline to correct cerebral edema. However, overly rapid correction of chronic hyponatremia can cause osmotic demyelination syndrome. The authors review the treatment of hyponatremia in order to provide clinicians with a sound approach in a variety of settings in which severity, symptoms, and underlying disease states influence therapy. Also discussed is the current role of vasopressin antagonists in treatment. http://www.ccjm.org/content/77/10/715.full.pdf+html  Cambios electolítricos: un método indirecto para valorar las complicaciones por la absorción del líquido de irrigación durante la resección transuretral de próstata; Un estudio prospectivo Electrolyte changes: An indirect method to assess irrigation fluid absorption complications during transurethral resection of prostate: A prospective study. Gupta K, Rastogi B, Jain M, Gupta PK, Sharma D. Department of Anesthesiology & Critical Care, N.S.C.B.Subharti Medical College, Subhartipuram, NH-58, Meerut - 250 004, U.P. India. Saudi J Anaesth. 2010 Sep;4(3):142-6. Abstract CONTEXT: Fluid absorption is inevitable complication of transuretheral resection of prostate and serum electrolytes changes can indirectly assess the irrigation fluid absorption. AIMS: To monitor the extent of 1.5% glycineirrigation fluid absorption during transurethral resection of prostate (TURP), by measuring the changes of serum sodium and potassium levels peri-operatively. SETTINGS AND DESIGN: This is a randomized prospective cohort observational study. MATERIALS AND METHODS: The 86 male patients of ASA grades I to III in the age group of 50 to 80 years, scheduled for elective TURP surgery under central neuraxial block, were studied. Their preoperative and post-operative serum sodium, potassium and calcium levels were measured. When duration of surgery exceeds 60 min, serum sodium and potassium levels were done intra-operatively with venous blood samples by using blood gas analyser. The height of irrigation fluid column was kept constant at 60 cm. These changes were correlated with the volume of irrigating fluid used, duration of procedure and the volume of prostate gland resected. STATISTICAL ANALYSIS USED: The values of pre and postoperative sodium, potassium and calcium serum levels were compared and statistical significance of the difference in values was assessed using Student's paired t test. RESULTS: Statistically significant reduction of serum sodium levels (hyponatremia) and elevation of serum potassium levels (hyperkalemia) were observed post-operatively, which was directly proportional to volume of irrigating fluid used, duration of procedure and volume of prostate gland resected. No significant changes in serum calcium level were observed. CONCLUSIONS: To measure serum electrolytes changes during TURP surgery, it is simple and economical method for indirect assessment of fluid absorption for early identification of TURP syndrome. http://www.saudija.org/temp/SaudiJAnaesh43142-5651788_154157.pdf

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