Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

1544 Vitiligo Volume Depletion and Edema

diuretics, salt wasting nephropathy, decreasedmineralocor-

ticoid activity

increased [Na] and decreased [Cl] or increased FENa and

decreased FECl (effect of nonreabsorbable anion)

vomiting (bicarbonaturia), ketonuria, urinary excretion of

penicillin salts

decreased [Na] and increased [Cl] or decreased FENa and

increased FECl (effect of increased UNH4V )

chronic diarrhea

➣Other tests indicative of increased renal reabsorption of Na and

water

urine:plasma creatinine >40:1

increased Uosmand increased urine specific gravity

differential diagnosis

■decreased total body Na, decreased EABV

➣extrarenal loss

diarrhea, fistula, vomiting/nasogastric suction, excessive

sweating

➣renal loss

diuretics

adrenal insufficiency

cerebral salt wasting

■increased total body Na, decreased EABV (edematous disorders)

➣congestive heart failure

➣cirrhosis

➣nephrotic syndrome

➣third-spacing

pancreatitis

peritonitis

extensive burns

■increased total body Na, increased EABV

➣acute glomerulonephritis

➣acute oligo-anuric renal failure

➣advanced end stage renal disease

management

■first ensure hemodynamics are stable