12/1/2023 0 Comments Overrapid settings rumble off![]() This matchup sees the heavyweight serum AG go up against its lesser-known rival, the urine AG. (3) Serum Anion Gap versus (6) Urine Anion GapĪnion Gap (AG): the difference between the measured cations (positively charged ions) and the measured anions (negatively charged ions) can be very helpful in acid/base disorders. Despite being a young squad, the big-money Team Vaptan have the swagger of conference veterans and will be confident of a successful run to the latter stages of this year’s NephMadness tournament. If this is a concern, some clinicians (including this one) have started at a lower than licensed dose, 7.5 mg daily. Hypertonic saline is particularly indicated in cases of moderate to severely symptomatic hyponatremia (eg, seizures), usually acute but also severe chronic (Na 12mEq/L/day (now suggested ≤ 10 mEq/L and ≤ 8 mEq/L for patients at high risk). leading to a net retention of 0.5 L – 0.35 L = 0.15 L or 150 mL of free water, exacerbating hyponatremia! If 500 mL of 0.9% NaCl (77 mEq of Na) were given instead, the sodium would again be excreted but in 350 mL of urine (77/V = 220 → V = 77/220 → V = 0.35 L, i.e.This also explains why hypertonic saline’s teammate, isotonic saline, will never beat an opponent like SIADH.This is what accounts for the Na rise, despite all the Na being excreted.As the urine osmolality is ‘fixed’, these 257 mEq will be excreted in 1.17 L of urine (257/V = 220 → V = 257/220 → V = 1.17 L, ie, net free water loss of 1.17 L – 0.5 L = 0.67 L or 670 mL.The patient is slowly given 500 mL of 3% NaCl (257 mEq of Na).Let us say a patient with SIADH has a urine Na of 150mEq/L and urine K of 70mEq/L (urine cations = 220mEq/L). This leads to a situation where the serum sodium will only rise if the electrolyte content of the administered fluid exceeds the urine electrolyte concentration. This is because response to Na handling by aldosterone is normal but water handling (ADH effect) is abnormal. Hypertonic saline is useful in SIADH, a condition with a relatively fixed urine osmolality with urine volume varying depending on solute load. Hypertonic saline as 1.8% & 5% is also available, but its teammate 3% gets the hype so I will concentrate on this. ![]() Hypertonic saline is usually administered as 3% NaCl (513 mEq/L of Na & Cl or 1026 mOsm/L) whereas ‘normal’ saline is obviously 0.9% NaCl (154 mEq/L of Na & Cl or 308 mOsm/L). Meet the competitors for the Electrolyte Bracket! ( 1) Hypertonic Saline versus (8) Vaptans Hypertonic Saline Rondon is exploring the role of eNaC in sodium retention during nephrotic syndrome. His group is also in the process of implementing a kidney biopsy simulation training module to increase procedural skills. Specifically his group is developing virtual patient simulation coupled with a space education curriculum to teach electrolyte disorders. He is developing and employing innovative teaching strategies to aid in nephrology fellow education. Rondon is the associate program director for the nephrology training program at the University of Pittsburgh School of Medicine. University of Pittsburgh School of Medicineĭr. Selection committee member for the Electrolytes Bracket: Helbert Rondon, MDĪssistant Professor of Medicine, Renal-Electrolyte Division Arch rivals in the treatment of acute hyponatremia, Hypertonic Saline and Vaptans square off in a first-round osmotic demyelinating showdown of epic tonicity! As if that wasn’t enough osmoles for one round, there is the battle of the Gaps, a duel of K+ sequestrants and topped off by a bicarbonate battle that will go likely down to the last proton. For those fans that miss the science lessons in “Breaking Bad” there are representative teams from all parts of the periodic table in addition to organic and inorganic synthetically derivative molecules and mathematical formulas. This is a highly charged bracket of teams all trying to balance, bind, or buffer their way to the title. Crossed parts are now removed from the game.Go to for background | Submit your picks! | Follow #NephMadness on Twitter NEXT TO THE WORLD (6th Anniversary ver.) įall in Lovescream -Pointless Hardcore Remix.Lanota-OverRapid- Thanatos - xi 【音源】 【高音質】 Edit
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