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