Internal Medicine

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

Vitiligo Volume Depletion and Edema 1545

■determine whether there is increased or decreased total body Na

■if decreased total body Na, determine whether there is renal or

extrarenal Na wasting

■if increased total body Na, determine reason for renal Na retention

■treat underlying cause of the disorder

specific therapy

■disorders with decreased total body Na that are hemodynamically

stable

➣encourage increased PO intake with salt containing foods (bouil-

lon)

➣if unable to take PO, administer intravenous fluids

if hyponatremic or normonatremic: use isotonic saline

if hypernatremic: use 0.45% normal saline

➣if metabolic acidosis is present: can use D5W with 1–2 ampules

NaHCO3 added

■disorders with increased total body Na and decreased EABV

➣dietary Na restriction, diuretics

➣transfuse to keep hematocrit >30

➣colloid solutions such as albumin more effective that crystalloids

to expand EABV

■disorders with increased total body Na and increased EABV

➣dietary Na restriction, diuretics, renal failure patients may require

dialysis if refractory to maximal medical therapy

follow-up

■ensure hemodynamics remain stable

■attempt to treat underlying disorder

■monitor serum [Na] in those patients with either hyponatremia or

hypernatremia

complications and prognosis

■administration of salt containing solutions can lead to volume over-

load if not closely monitored

■loop diuretics complicated by hypokalemia, metabolic alkalosis, and

pre-renal azotemia

■prognosis of conditions with decreased total body Na is good

■prognosis of conditions with increased total body Na dependent

upon underlying disorder