By Lerma E., Berns J.S., Nissenson A.
An entire clinically concentrated advisor to handling the total spectrum of kidney ailments and hypertensionAccessible, concise, and up to date, present prognosis & remedy Nephrology & high blood pressure features:- exceptional scientific evaluation of all significant ailments and issues, from end-stage renal affliction to fundamental and secondary high blood pressure- a pragmatic, learn-as-you-go method of diagnosing and treating renal problems and high blood pressure that mixes ailment administration strategies with the newest clinically confirmed cures- up to date assurance of transplantation medication and need-to-know interventional approaches- an enormous evaluate of subspecialty concerns: renal ailment within the aged, diabetic nephropathy, serious care nephrology, and dialysis- specialist authorship from in demand clinicians within the parts of kidney ailment, dialysis, and high blood pressure
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A rapid decline in the sodium concentration or deterioration (after improvement) in neurologic status suggests the development of cerebral edema and requires temporary discontinuation of water replacement. Patients with neurogenic diabetes insipidus and an intact thirst mechanism do not develop hypernatremia if water is available. Treatment is aimed at relieving the inconvenience of persistent polyuria and polydipsia. In the acute setting after trauma or hypophysectomy, aqueous vasopressin is preferred because of its short duration of action.
Gestational diabetes insipidus—An unusual form of diabetes insipidus resistant to vasopressin has been described in pregnancy. Rather than renal insensitivity to the hormone, placentally derived circulating vasopressinase neutralizes circulating vasopressin. Desmopressin (DDAVP) is not affected by vasopressinase and is effective in treating the disease. C. Hypernatremia with an Increased Extracellular Volume Hypernatremia with an increased total body volume is the least common form of hypernatremia and is most often associated with administration of hypertonic sodium chloride or hypertonic sodium bicarbonate during resuscitative efforts.
Treatment A. Euvolemic Hyponatremia Most commonly, euvolemic hyponatremia develops slowly and is often relatively asymptomatic. The principal risk in adapted patients is not hyponatremia, per se. Rather it is overzealous correction that either decreases the serum sodium further or increases it too quickly. Accordingly, therapy for asymptomatic patients is conservative, consisting initially of water restriction and, if possible, removal of the inciting etiology. In most cases, restricting ﬂuid intake to less than 1 L/24 hours will be sufﬁcient to allow the sodium to rise slowly.
CURRENT Diagnosis & Treatment Nephrology & Hypertension by Lerma E., Berns J.S., Nissenson A.