# Hyponatremia — GCMD Library living collection

Everything in the library about hyponatremia — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 22 cited statements

## Episodes
### Evidence & Research
- [Isotonic maintenance fluid: Practice Gap discussion at Update Course 2018](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346) — video · 5:57 · [machine version](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346.md)
- [Maintenance Fluids in Resuscitation: 2018 Pediatric Surgery Practice Gap #4](https://library.globalcastmd.com/watch/maintenance-fluids-in-resuscitation-2018-pediatric-surgery-practice-gap-4-1458) — video · [machine version](https://library.globalcastmd.com/watch/maintenance-fluids-in-resuscitation-2018-pediatric-surgery-practice-gap-4-1458.md)
- [APSA 2018 Practice Gaps](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310) — video · [machine version](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=0) Clinical vignette and historical context of IV fluid selection (Ep 1)
- [1:16](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=76) Evidence for isotonic maintenance fluids and the hyponatremia problem (Ep 1)
- [3:19](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=199) Dissemination of new practice and audience response (Ep 1)
- [4:44](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=284) Special populations and future directions (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/maintenance-fluids-in-resuscitation-2018-pediatric-surgery-practice-gap-4-1458?t=0) Practice Gap #4: Isotonic vs Hypotonic Maintenance Fluids (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=0) Restrictive Transfusion Protocols and Early Enteral Feeding in Pancreatitis (Ep 3)
- [3:20](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=200) Ovarian Torsion Management, VTE Prophylaxis, and Physician Wellness (Ep 3)
- [7:39](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=459) Firearm Injury Prevention Counseling (Ep 3)
- [13:13](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=793) Isotonic Fluid Continuation and Wilms Tumor Lymph Node Sampling (Ep 3)
- [18:03](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1083) Non-Operative Management of Uncomplicated Appendicitis (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Iatrogenic hyponatremia is one of the biggest problems in hospitals, related to ADH physiology and the use of hypotonic fluids rather than normal saline." (clinical) [Ep 1 · 1:23](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=83)
- "Children become hyponatremic because they are given half normal saline, and the data on this are clear." (clinical) [Ep 1 · 1:23](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=83)
- "The correct maintenance fluid for a 15-year-old post-colectomy patient is D5 normal saline with 20 milliequivalents of potassium." (guideline) [Ep 1 · 2:05](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=125)
- "The American Academy of Pediatrics is coming out with a consensus statement on isotonic maintenance fluids (anticipated as of March)." (guideline) [Ep 1 · 2:31](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=151)
- "Hospitalized children develop hyponatremia because they receive less than isotonic (hypotonic) solutions, leading to cerebral edema and other complications." (clinical) [Ep 1 · 2:31](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=151)
- "The traditional teaching was to resuscitate with isotonic fluid and then convert to hypotonic maintenance fluids; the new practice is to keep patients on isotonic fluid to prevent hyponatremia." (guideline) [Ep 1 · 2:58](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=178)
- "At ABSA, 48% of respondents correctly identified isotonic fluid as the answer, which the speakers considered a high number given the radical change from traditional teaching." (epidemiological) [Ep 1 · 3:30](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=210)
- "Hypotonic fluids were originally developed based on theoretical calculations of sodium and chloride losses by a scientist approximately 100 years ago, not on evidence from real patients." (clinical) [Ep 1 · 4:24](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=264)
- "Newborn babies are different because their kidney function is immature when first born, so the amount of electrolytes given changes over the first couple of days of life." (clinical) [Ep 1 · 4:47](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=287)
- "Term newborns on the first day of life should receive D10W (dextrose 10% in water) with no saline." (guideline) [Ep 1 · 4:47](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=287)
- "In adult critical care literature, practice is shifting from normal saline to lactated Ringer's as the normal isotonic solution, and the same shift is expected to occur in pediatrics." (opinion) [Ep 1 · 5:14](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=314)
- "Lactated Ringer's is a more physiologic isotonic solution than normal saline." (clinical) [Ep 1 · 5:40](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=340)
- "There is not yet literature in children supporting the use of D5 lactated Ringer's, but it is anticipated." (opinion) [Ep 1 · 5:40](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=340)
- "Restrictive transfusion protocols using target hemoglobin of 7 instead of 8, 9, or 10 show no difference in mortality" — Alex Gibbons (host_summary) [Ep 3 · 0:27](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=27)
- "Sickle cell disease is an exception to restrictive transfusion protocols, requiring hematocrit around 30 or HBSS below 50-60%" (clinical) [Ep 3 · 2:01](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=121)
- "Early enteral feeding in pancreatitis decreases morbidity, infectious complications, and overall mortality" — Alex Gibbons (host_summary) [Ep 3 · 2:27](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=147)
- "Nasogastric feeding is equal to nasojejunal feeding in pancreatitis and equally tolerated" — Alex Gibbons (host_summary) [Ep 3 · 2:27](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=147)
- "Ultrasound is not a great tool for diagnosis of ovarian torsion" — Rae Hanke (host_summary) [Ep 3 · 4:11](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=251)
- "In ovarian torsion, even if the ovary looks black and dead after detorsion, leave it in place because ovaries can still recover and this helps preserve fertility" — Alejandro Cassar (host_summary) [Ep 3 · 4:39](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=279)
- "For low bleeding risk trauma patients, VTE prophylaxis should include SCDs and low molecular weight heparin" — Rae Hanke (host_summary) [Ep 3 · 4:59](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=299)
- "For high bleeding risk trauma patients, use SCDs until ambulatory, then do screening ultrasound on ICU day 7" — Rae Hanke (host_summary) [Ep 3 · 4:59](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=299)
- "Institutional policy at one center applies VTE prophylaxis with low molecular weight heparin to patients age 12 and over" (clinical) [Ep 3 · 5:55](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=355)
- "High risk criteria for VTE in trauma include femur fractures, cervical spine fracture, and intubation" (clinical) [Ep 3 · 5:55](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=355)
- "Kids with IBD are probably the most at-risk group for deep venous thrombosis" — Rae Hanke (clinical) [Ep 3 · 6:52](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=412)
- "Burnout directly impacts patient care and outcomes" — Rae Hanke (host_summary) [Ep 3 · 6:52](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=412)
- "Support systems for physician wellness need to be proactive because when burnt out, surgeons are not likely to seek help" — Rae Hanke (host_summary) [Ep 3 · 6:52](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=412)
- "Physicians should ask parents if there is a firearm in the home, how it is stored, whether it is locked and loaded, whether ammunition is kept separate, and who has access" (host_summary) [Ep 3 · 12:19](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=739)
- "Current strategy should be to continue isotonic fluids throughout hospitalization rather than switching to hypotonic maintenance fluids" — Alex Gibbons (host_summary) [Ep 3 · 13:13](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=793)
- "Continuing isotonic fluids decreases the risk of hyponatremia and had similar mortality otherwise" — Alex Gibbons (host_summary) [Ep 3 · 13:13](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=793)
- "In Wilms tumor surgery, failing to take lymph nodes automatically upstages the patient" — Alex Gibbons (host_summary) [Ep 3 · 17:10](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1030)
- "Pulmonary metastasis in Wilms tumor does not preclude doing a primary nephrectomy" — Alex Gibbons (host_summary) [Ep 3 · 17:10](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1030)
- "In Wilms tumor with pulmonary metastases, it is still important to take lymph nodes because local disease treatment has an impact on abdominal disease treatment regardless of lung mets" (clinical) [Ep 3 · 19:21](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1161)
- "Non-operative management of uncomplicated appendicitis has decreased days of hospitalization, decreased days of disability, and equal outcome measures otherwise" — Rae Hanke (host_summary) [Ep 3 · 19:49](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1189)
- "In the adult IMPACT trial from Finland at 5 years, 41% of the non-operative appendicitis management group underwent appendectomy" — Alex Gibbons (host_summary) [Ep 3 · 22:45](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1365)
- "In a survey for a Seattle-based multi-institutional study, parents stated they would accept a 50% chance of success as acceptable for enrolling in non-operative appendicitis management study" (epidemiological) [Ep 3 · 23:50](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1430)
- "Traditional dogma was to switch from isotonic to hypotonic fluids once reaching maintenance phase" (host_summary) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/maintenance-fluids-in-resuscitation-2018-pediatric-surgery-practice-gap-4-1458?t=0)
- "New recommendation is to continue with isotonic fluids during maintenance phase" — Alex (host_summary) [Ep 2 · 0:23](https://library.globalcastmd.com/watch/maintenance-fluids-in-resuscitation-2018-pediatric-surgery-practice-gap-4-1458?t=23)
- "Continuing isotonic fluids decreases the risk of hyponatremia without any adverse consequences" — Alex (host_summary) [Ep 2 · 0:23](https://library.globalcastmd.com/watch/maintenance-fluids-in-resuscitation-2018-pediatric-surgery-practice-gap-4-1458?t=23)
- "Traditional training involved starting with normal saline or LR and then switching to half normal saline or quarter normal saline" — Alex (guideline) [Ep 2 · 0:23](https://library.globalcastmd.com/watch/maintenance-fluids-in-resuscitation-2018-pediatric-surgery-practice-gap-4-1458?t=23)
- "Despite available evidence, most practitioners are still reluctant to adopt isotonic maintenance fluids" (opinion) [Ep 2 · 0:48](https://library.globalcastmd.com/watch/maintenance-fluids-in-resuscitation-2018-pediatric-surgery-practice-gap-4-1458?t=48)
- "Many practitioners still order hypotonic fluids on the floor" (clinical) [Ep 2 · 0:48](https://library.globalcastmd.com/watch/maintenance-fluids-in-resuscitation-2018-pediatric-surgery-practice-gap-4-1458?t=48)

## Changelog
- Sep 25: 3 items added automatically

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