renal

Hypochloremic (“Contraction”) Alkalosis

Metabolic alkalosis is a derangement characterized by increased plasma bicarbonate (HCO3-), resulting in a pH > ~7.45. This can be a product of hydrogen ion (H+) loss (e.g., vomiting or renal losses), intracellular shifting...

Desmopressin (DDAVP) Clamp

Patients with severe hyponatremia ( < 120 mEq/L) can present with altered mentation, seizures, lethargy, and even coma. After identifying the likely cause(s), treatment is centered around a combination of sodium replacement (usually with...

Chlorothiazide

Chlorothiazide (Diuril) is a thiazide diuretic that inhibits the sodium-chloride cotransporter in the nephron's distal convoluted. As such, it increases the excretion of water, sodium, and chloride; however, not to the degree of loop...

Hyponatremia Correction For Hyperglycemia

Sodium is the primary cation (positive-charged ion) in the extracellular space. Therefore, dilutional hyponatremia can occur if free water is added to the extracellular space from fluid shifts and infusions. Let's look at this basic...

Hypernatremia And Free Water Deficit

Sodium (Na) fluctuations portend increased in-hospital death for ICU patients, and when working them up, it's essential to determine if these disorders are acute or chronic (> 48 hours or unknown duration). For hypernatremia...

Lactated Ringers And Normosol In Hyperkalemia

As an intensivist and anesthesiologist, I spend considerable time pondering the physiology and evidence for practices and questioning dogma rampant in the ICU/OR settings. I've heard one recurrent theme: the fear of using Lactated...

Green Urine Discoloration

Urine color is often under-appreciated in working up a patient's clinical status (especially in the ICU and OR). "Highlighter" yellow urine is often seen in patients on B vitamin complexes (it’s a water-soluble vitamin,...

Mannitol

Mannitol is a carbohydrate often administered as a hypertonic solution that is freely filtered by the renal glomerulus and not reabsorbed. Therefore, it serves as an osmotic diuretic that, if left unchecked, can lead...

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