hyponatremia

Started by Debh
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Debh

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We are facing some dilemma with a patient and would like to ask for your advice: a 75 year old woman, hypertensive , diabetic, scheduled for an elective knee arthroplasty . She uses at home Hydralazyne, Olmesartan, vidagliptin, rosuvastatin and hydrochlorotiazide. She has a history of splenectomy some years ago, but she doesn`t know why. She thinks it is because she had a "low white blood cell count", as she explains. Her lab exams show 500.000 platelets and Na= 127mEq/l. Renal function ok. Otherwise normal except for glucose 138. The question is: should we continue with elective surgery? Should the Na be corrected before surgery? What would be the lowest safe sodium limit for an elective procedure?
 
Debh said:
We are facing some dilemma with a patient and would like to ask for your advice: a 75 year old woman, hypertensive , diabetic, scheduled for an elective knee arthroplasty . She uses at home Hydralazyne, Olmesartan, vidagliptin, rosuvastatin and hydrochlorotiazide. She has a history of splenectomy some years ago, but she doesn`t know why. She thinks it is because she had a "low white blood cell count", as she explains. Her lab exams show 500.000 platelets and Na= 127mEq/l. Renal function ok. Otherwise normal except for glucose 138. The question is: should we continue with elective surgery? Should the Na be corrected before surgery? What would be the lowest safe sodium limit for an elective procedure?
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Is she symptomatic? What is the acuity with which the hyponatremia developed? The slower it developed, the slower you should correct it.
 
To me, this sounds like poor medical management. I would say this patient has an allergy to HCTZ and should be on another BP medication. It is the HCTZ causing the hyponatremia. Much less likely on the list are salt wasting syndrome or SIADH, but there is nothing in the history to suggest those things. This patient needs to be worked up by a PCP before proceeding for an elective case. But what happens in my group is the surgeon will jump up and down and they will find another anesthesia provider to do the case. You really don't want this patient seizing after surgery and falling down, ending up with a subdural hematoma. The lawsuit won't be pretty.
 
probably not best to have the pt on a diuretic day of surgery. don't think oral hypoglycemics are great either (like a glipizide) for day of surgery.

depends on fluid status, glycemic status, chronicity vs. acuity of the hypoNa.

i'd attempt to ID the source of the hypoNa.
 
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