Hyponatremia

A review of hyponatremia, including symptoms, etiologies, diagnostic work-up, and treatment. Specific attention is given to the use of hypertonic saline, the osmotic demyelination syndrome (a.k.a. central pontine myelinolysis), as well as distinguishing SIADH from cerebral salt wasting.

[StrongMed]

Thanks for the feedback. I know many of my viewers are non-native English speakers. I try to balance between speaking slower so people can understand, without speaking too slowly and making an already long video even longer. I've tried to improve the audio quality over the last 2 years, predominantly to help the non-native English speakers, and I include more text on each slide than I do when teaching in person in the US. It's not perfect for everyone, but it's the best balance I can do.

[jalalbaig]

Also, thank you again for the invaluable contribution you're making to online medical education through these various videos.

[StrongMed]

...Hopefully, someday YouTube will create a feature in which videos can be played back at different speeds. For example, one viewer could play the video at 90% full speed to help understand what might be a different language from his/her primary one, while another viewer could play the video at 110% full speed in order to view videos more quickly, and watch more of them per unit time. That would solve this problem, though I suspect there are significant technical limitations to this.

[StrongMed]

Thanks for the suggestion! I've looked at a couple of platforms for delivering content on-line in a more robust fashion than YouTube, but despite their huge support and publicity, I haven't felt completely convinced of their effectiveness yet. Plus, most invite their course creators (not the other way around), and the type and purpose of content I try to deliver works best if it's on-demand. Not to say I wouldn't be interested if Coursera gave me a call...

[sutirthahajra]

the best electrolyte and ABG analysis that i have ever come across. plz introduce more videos in medicine and surgery if possilbe. thanks a ton

[laurentiu]

I was looking  many years for  this lecture . Comprehensive and easy to remember . Thank you .

[StrongMed]

I had similar teaching as you when in med school, and was initially confused in residency when I saw attendings prescribing salt tabs for SIADH. 2 key principles: First, you are correct that salt tabs + water = IV saline, which is why it's important to always combine salt tabs with fluid restriction. Salt tabs + unlimited water risks making SIADH worse, just like saline...

[AleenaHamid-tv]

One of the best lectures about a complex such as this..thank you so much..

[rmsdudqkr]

Just want to say a big Thank You Dr. Strong, for all your videos! Very helpful as supplementary material (in fact most of the time, supplanters) to my lectures in medical school.

[nsas]

Thank you very much for this complete and simplified explanation of hyponatremia....you are a very fascinating teacher.

[h.q.]

The best video for hyponatremia i have ever watched 👍🏻

[haseebmahajan]

Concept clearance attitude is commendable 🥰

[StrongMed]

...There's a surprisingly small amount in the literature about the use of oral salt tablets for long-term management of SIADH (even compared to the conceptually similar treatment option of oral urea). I've seen salt tabs used a number of times with apparent effect, though I appreciate that my personal case series of a dozen patients doesn't substitute for a large RCT. However, physiologic principles do seem to support the approach as well. Hope that helps!

[kalldagreat]

In my humble opinion the hyponatremia etiologies by mechanism is lil confusing, for the ease of remembering them I'd rather classify them by:
1.) Increase in the serum water content 
2.) Decrease in the serum sodium content (in actual or relatively to the increment of other serum substances)

For the list of etiologies for the increase in serum water content:
1.) Primary Polydipsia
2.) SIADH
3.) Renal Failure
4.) Endocrinopathy

Whereas the etiology for the decrease in serum sodium content:
1.) Low BP (shock) or any form of trauma that leads to blood loss
2.) GI losses 

Eric's Medical Lectures Please enlighten me If there's any correction or let me know if this way of remembering is more practical or relatively easier besides classifying them by the volume status.

[yuiyui]

Very​ ​deep​ summarized, Thank​​you​❤

[henryach]

Great video. Other hyponatremia videos on Youtube don't explain the physiology properly.

You mention loop diuretics as a treatment for SIADH at the end but I can't find any mention of these before 35:16. Doesn't make intuitive sense so would have been good to have an explanation.

[StrongMed]

...Second, you're absolutely right that the oral salt will likely all be excreted. However, since sodium excretion requires water excretion, as long as the amount of increased oral water that might accompany the salt tabs is less than the min amount of water necessary to excrete the oral salt load (i.e. more water is lost than gained), the serum sodium should improve.

[Pou]

This is awesome! I was recently diagnosed with a tumor in my pituitary. For the past 3 months, I have been to the hospital 6 times and was found I was hyponatremic. One of those visits, I was put in the ICU for 3 days with sodium levels at 112 (forgetting the nomenclature). It was awful! For I moment, I really felt I wasn't going to make it. I gues it doesn't help that I don't have a thyroid, and have Dysautonomia (POTS and Gastroparesis). I also have RA. My rheumatologist said he could not believe he was seeing me alive. My cardiologist believes I have SIADH, and has reffered me to a more experienced endocrinologist, and GI expert in motility.
I am either a complicated woman or a woman with some complications 😉
Thank you for this. It helps to understand ☺

[StrongMed]

Several other viewers have asked for this topic in recent months, and it's on my list of upcoming videos. I wish I could give you an approximate target date, but it's hard for me to predict. I promise I'll get to it at some point!

[sunving]

Thank you Dr Strong, this is an excellent lecture, one need to know to take care hyponatrimia, so thorough.