12.12.04 Sodium

Classification

Central pontine myelinolysis

• • Affects CN III - VII

  • Characteristic feature is gaze palsies

    • Conjugate (complex) palsy

    • INO

  • Also:

    • Long tract signs (spasticity)

    • Reduced level of consciosuness

Marathons

• • Perfect storm:

    • Complete loss of glycogen

    • Rise in vasopressin

    • Hypotonic fluids

  • Treat with twice-normal saline

Notes

• • Vasopressin is a STRESS HORMONE

    • Hyponatraemia in marathons

    • Hyponatraemia with MDMA

  • Never give sodium or fluids together with diuretics

  • Never give hyperosmolar saline without consultant approval

  • Kidneys filter per day:

    • 180 L of fluid

    • 2 kg of NaCl

  • Correct sodium at no more than 8 mM per day

    • Use no more than 500 ml saline per day