Comments on: 15 days at the VA – day 5 http://www.medrants.com/archives/5119 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: david http://www.medrants.com/archives/5119/comment-page-1#comment-530818 david Tue, 22 Dec 2009 01:18:08 +0000 http://www.medrants.com/?p=5119#comment-530818 what was his serum sodium? what was his serum sodium?

]]> By: NornMedic http://www.medrants.com/archives/5119/comment-page-1#comment-530817 NornMedic Tue, 22 Dec 2009 00:11:33 +0000 http://www.medrants.com/?p=5119#comment-530817 Palliative care discussed when there are potential therapeutic options available? wtf? Palliative care discussed when there are potential therapeutic options available?

wtf?

]]> By: cory http://www.medrants.com/archives/5119/comment-page-1#comment-530815 cory Mon, 21 Dec 2009 13:04:09 +0000 http://www.medrants.com/?p=5119#comment-530815 Does hyponatremia occur because of decreased intravascular volume or do they often coexist ? Cause and effect or common cause?  And what is decreased intravascular volume anyway? It can't be directly measured unless you have massive acute fluid losses. IT's a pretty nebulous concept in the chronic state. I have always thought edematous states like cirhossis result from avid sodium retention and an excess of total body sodium. For whatever reason, portal pressure, decreased oncotic pressure, this fluid is not retained in the vascular space creating edema and ascites.. Many patients have an increased sense of thirst, you often have to hide water from them, (?angiotensin system) and so you are faced with a total body excess of sodium, undeniable and an intravascular excess of free water. Absent correcting the liver problem the only real treatment is sodium restriction, mild diuresis (so as not to aggravate the liver problem) and water restriction. Thoughts?    Does hyponatremia occur because of decreased intravascular volume or do they often coexist ? Cause and effect or common cause? 
And what is decreased intravascular volume anyway? It can't be directly measured unless you have massive acute fluid losses. IT's a pretty nebulous concept in the chronic state.
I have always thought edematous states like cirhossis result from avid sodium retention and an excess of total body sodium. For whatever reason, portal pressure, decreased oncotic pressure, this fluid is not retained in the vascular space creating edema and ascites..
Many patients have an increased sense of thirst, you often have to hide water from them, (?angiotensin system) and so you are faced with a total body excess of sodium, undeniable and an intravascular excess of free water.
Absent correcting the liver problem the only real treatment is sodium restriction, mild diuresis (so as not to aggravate the liver problem) and water restriction.
Thoughts?   

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