Internal Medicine

Biography

Biography: Khalil Ahmed

Abstract

Dysnatremia is commonly seen in intensive care setting. If it is not timely diagnosed and corrected, can lead to serious consequences. Early detection and correction may improve prognosis especially in neurocritical care.  It can be hypo or hypernatremia, both have worst effect on overall prognosis if not corrected timely.           Hypernatremia is defined if serum sodium is > 145 mmol/liter. It is due to relative water depletion with total body sodium content either normal, low or high. Diabetes insipidus is one of the most common causes of hypernatremia in neurocritical care. Hyonatremia is the other entity which accounts about 15-20% of all emergency admissions, and can affect on prognosis significantly. In spite of much understanding of the topic, its management remains still problematic. Hyponatremia is defined as if serum sodium < 135 mmol/liter, and it is classified as mild, moderate & severe on the basis of serum level. On the basis of onset duration, it is defined whether acute or chronic hyponatremia. Broadly speaking dilutional & volume depletion are the two most common causes of hyponatremia, remaining are endocrinal, use of diuretics and certain drugs leading to hyponatremia. The management of either entity depends upon the cause leading to hypo or hyernatremia. It is of prime importance to avoid overcorrection, during management of hyponatremia or hpernatremia. Different calculations are used to calculate total sodium deficit and total water deficit before starting correction. Special care is needed in neurocritical care like patients with acute traumatic brain injuries and acute stroke for early detection and correction of serum sodium levels to avoid adverse effect on overall prognosis. Hyponatremia is broadly classified into hypotonic, hypertonic or isotonic based on measured serum osmolality.