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differential algorithm hypernatremia management pathophysiology table alkalosis anticoagulation causes checklist chloride citrate defects epithelial framework hypokalemia hypophosphatemia hypotonic inherited ischemic
Gitelman Syndrome Pathophysiology Gitelman Syndrome is a rare autosomal recessive salt-losing tubulopathy with a prevalence of 1-
Gitelman Syndrome ... thiazide-sensitive sodium-chloride ... in the distal tubule ... Contraction → ↑ Renin ↑ Ca ... #nephrology #diagnosis
Hypernatremia Diagnosis and Workup Step 1 . Repeat the sodium concentration. Step 2. Check plasma osmolality. NORMAL PLASMA
Hypernatremia Diagnosis ... Repeat the sodium ... • nephrotic syndrome ... #Diagnosis #Workup ... #Algorithm #Nephrology
Hypernatremia - Differential Diagnosis Workup Algorithm 1) Check Urine Osmolality: > 600 mOsm/kg - Implies extrarenal mechanism
Differential Diagnosis ... Workup Algorithm ... • Euvolemic (Low ... , Cushing syndrome ... #nephrology #sodium
Modified Hyponatremia Algorithm Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants Hypotonic Hyponatremia: • ADH ON (UOsm > 100):
Modified Hyponatremia ... Cirrhosis, Nephrotic syndrome ... Primary polydipsia, Low ... #Algorithm #diagnosis ... #sodium #nephrology
Inherited Defects in Kidney Tubule Epithelial Cells Renal glucosuria - Na+-dependent glucose cotransporter Cystinuria - Amino acid transporter Bartter
ascending limb Gitelman ... cell epithelial sodium ... of epithelial sodium ... Defects #Kidney #Nephrology ... #Diagnosis #Differential
Volume Based Approach to Hyponatremia Hypovolemic, Serum uric acid >4 • Urine Na <20: Extra-renal losses •
Based Approach to Hyponatremia ... Hypothyroidism, Low ... Cirrhosis, Nephrotic syndrome ... #algorithm #diagnosis ... #sodium #low #nephrology
How do you work up an ischemic CVA? A) Initial Evaluation • ABCs • IV access, monitor
How do you work ... suspicion) • +/- bubble ... #stroke #workup ... #diagnosis #checklist ... #neurology
Physiologic Approach to Hypotonic Hyponatremia The next time you have a case of hypotonic hyponatremia, give the
can be high or low ... Cirrhosis, Nephrotic syndrome ... #differential #diagnosis ... #table #sodium ... #nephrology
Gitelman Syndrome Overview What? • Inherited (AR) hypokalemic salt-losing tubulopathies affecting the thiazide-sensitive sodium chloride cotransporter • Gitelman's syndrome
Gitelman Syndrome ... thiazide-sensitive sodium ... alkalosis • Normal or low ... #Syndrome #diagnosis ... #nephrology #management
Workup for Hypophosphatemia - Differential Diagnosis Framework Rule out spurious hypophosphatemia: paraproteinemia, acute leukemia Measure Urine Fractional Excretion
Workup for Hypophosphatemia ... - Differential Diagnosis ... • Normal or Low ... , CA Inh., Osmotic ... #phosphate #nephrology
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