Saturday, December 17, 2005

Hyponatremia: must reads for hospital physicians

An excellent review (via Medscape) on hyponatremia appeared recently in Clinical Endocrinology. Other general reviews of note are linked here (open access full text) [1 ] [2 ]. This review from a few years ago in Archives of Internal Medicine addresses the underappreciated distinction between osmololarity and tonicity as well as the related concepts of effective and ineffective osmoles (not light reading but important—a classic article worth having in the original).

article from CMAJ, though dated, is important in that it highlights selective serotonin reuptake inhibitors as an under recognized cause of hyponatremia.

Finally there is the problem of post operative hyponatremia. Although it occurs in a variety of post operative settings, hyponatremia after orthopedic surgery is of particular interest to hospitalists for a couple of reasons. First, there has been recent interest in hospitalist collaboration in the management of orthopedic surgical patients. Secondly, hyponatremia after orthopedic surgery has been noted sufficiently frequently to warrant special attention [3].
It seems to be more of a problem in female patients and is often aggravated by recent thiazide diuretic use.

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