Podcasts about Hypernatremia

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the April 2025 Emergency Medicine Practice article, Sodium Disorders in the Emergency Department: A Review of Hypernatremia and HyponatremiaHypernatremia (High Sodium Levels)Definition: Sodium level greater than 145 mEq/LBreakdown into three categories based on total body water statusHypovolemic HypernatremiaEuvolemic HypernatremiaHypervolemic HypernatremiaCommon causes and conditions associatedHyponatremia (Low Sodium Levels)Definitions: Mild (130-135 mEq/L), Moderate (125-129 mEq/L), Profound (< 125 mEq/L)Breakdown into three categoriesPseudo HyponatremiaHypovolemic HyponatremiaEuvolemic HyponatremiaHypervolemic HyponatremiaCommon causes and conditions associatedTreatment Guidelines and StrategiesEmphasizing slow correction to avoid complications like cerebral edema and osmotic demyelination syndromeSuggested treatment rates for acute and chronic conditionsSpecial ConsiderationsAddressing severe cases and the importance of proper diagnosticsPre-hospital care considerations and scenariosPediatrics and consideration of child abuse in sodium disordersFive Things That Will Change Your PracticeCentral lab sodium values over point-of-care for accuracyRectal temperature checks in endurance athletesLoop diuretics for hypervolemic hyponatremia (e.g., CHF patients)Enteral treatment for hypernatremia, if possibleConsidering COVID-19 as a possible cause for new onset SIADH 

Listen as Dr. London Smith (.com) and his producer Cameron discuss Hypernatremia Due to Nephrogenic Diabetes Insipidus with special guest Charles McJingles (Sumner LeVeque). Not so boring! https://www.patreon.com/join/jockdocpodcast Hosts: London Smith, Cameron Clark. Guest: Sumner LeVeque. Produced by: Dylan Walker Created by: London Smith

Listen as Dr. London Smith (.com) and his producer Cameron discuss Hypernatremia Due to Central Diabetes Insipidus with special guest Tinkle the Elf (Quinn Avallon). Not so boring! https://www.patreon.com/join/jockdocpodcast Hosts: London Smith, Cameron Clark. Guest: Quinn Avallon. Produced by: Dylan Walker Created by: London Smith

We discuss the approach to diagnosing and managing hypernatremia in the emergency department. Hosts: Abigail Olinde, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Hypernatremia.mp3 Download Leave a Comment Tags: Electorlye Show Notes Episode Overview: Introduction to Hypernatremia Definition and basic concepts Clinical presentation and risk factors Diagnosis and management strategies Special considerations and potential complications Definition and Pathophysiology: Hypernatremia is defined as a serum sodium level over 145 mEq/L. It can be acute or chronic, with chronic cases being more common. Symptoms range from nausea and vomiting to altered mental status and coma. Causes of Hypernatremia based on urine studies: Urine Osmolality > 700 mosmol/kg Causes: Extrarenal Water Losses: Dehydration due to sweating, fever, or respiratory losses Unreplaced GI Losses: Vomiting, diarrhea Unreplaced Insensible Losses: Burns, extensive skin diseases Renal Water Losses with Intact AVP Response: Diuretic phase of acute kidney injury Recovery phase of acute tubular necrosis Postobstructive diuresis Urine Osmolality 300-600 mosmol/kg Causes: Osmotic Diuresis: High glucose (diabetes mellitus), mannitol, high urea Partial AVP Deficiency: Incomplete central diabetes insipidus Partial AVP Resistance: Nephrogenic diabetes insipidus Urine Osmolality < 300 mosmol/kg Causes: Complete AVP Deficiency: Central diabetes insipidus

Contributor: Aaron Lessen MD Educational Pearls: The case: A gentleman came in from a nursing home with symptoms concerning for sepsis. He was hypotensive, hypoxic, febrile, and mentally altered. His past medical history included previous strokes which had left him with deficits for which he required a feeding tube. Initial workup included some point of care labs which revealed a sodium of 165 mEq/L (normal range 135-145) Hypernatremia What causes it? Dehydration, from insufficient fluid intake. This might happen in individuals who cannot drink water independently, such as infants, elderly, or disabled people, as was the case for this patient. Other causes of dehydration/hypernatremia include excessive sweating; diabetes insipidus; diuretic use; kidney dysfunction; and severe burns which can lead to fluid loss through the damaged skin. How do you correct it? Need to correct slowly, not more than 10 to 12 meq/L in 24 hours Can do normal saline (0.9%) or half saline (0.45%) and D5, at 150-200 mL per hour. Check the sodium frequently (every 2-3 hours) Will likely need ICU-level monitoring What happens if you correct it too quickly? Cerebral edema Seizures Bonus fact: Correction of hyponatremia too quickly causes osmotic demyelination syndrome (ODS). References Chauhan, K., Pattharanitima, P., Patel, N., Duffy, A., Saha, A., Chaudhary, K., Debnath, N., Van Vleck, T., Chan, L., Nadkarni, G. N., & Coca, S. G. (2019). Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients. Clinical journal of the American Society of Nephrology : CJASN, 14(5), 656–663. https://doi.org/10.2215/CJN.10640918 Lindner, G., & Funk, G. C. (2013). Hypernatremia in critically ill patients. Journal of critical care, 28(2), 216.e11–216.e2.16E20. https://doi.org/10.1016/j.jcrc.2012.05.001 Muhsin, S. A., & Mount, D. B. (2016). Diagnosis and treatment of hypernatremia. Best practice & research. Clinical endocrinology & metabolism, 30(2), 189–203. https://doi.org/10.1016/j.beem.2016.02.014 Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSIII

HOST: Andy Herber, P.A.-C. GUEST: Mira T. Keddis, M.D. Join our host, Andy J. Herber, P.A.-C., as he explores Hyponatremia and Hypernatremia; common findings in both the inpatient and outpatient settings. Sodium disorders are associated with an increased morbidity and mortality for patients. Guest, Mira T. Keddis, M.D. , renown Mayo Clinic Nephrologist, joins the podcast to provide guidance on understanding evaluations and management of sodium abnormalities. Mayo Clinic Talks: Lab Medicine Edition | Mayo Clinic School of Continuous Professional Development Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Hypernatremia occurs in up to one fourth of ICU patients. The following episode covers the basics of understanding the critical factors in hypernatremia.    For further reading: https://emcrit.org/ibcc/hypernatremia/  

Lauren and JJ investigate the cause of neurologic signs in a dog. This episode includes a review of the management of bromethalin ingestion, as well as a review of the management of hypernatremia caused by activated charcoal administration. Sources: (1) Ball, A. (2014). Managing hypernatremia after activated charcoal administration. Veterinary Medicine, 109(4), 126-130. (2) Brister, J., Gwaltney-Brant, S., & Dekker, M. (2021). Bromethalin toxicosis (canine). VINcyclopedia of Diseases. www.vin.com (3) Brister, J., Gwaltney-Brant, S., & Dekker, M. (2021). Anticoagulant rodenticide toxicosis (canine). VINcyclopedia of Diseases. www.vin.com (4) Rothrock, K., & Shell, L. (2021). Hypernatremia (canine). VINcyclopedia of Diseases. www.vin.com (5) Veterinary Information Network (2017). Charcoal, activated. VIN Veterinary Drug Handbook. www.vin.com

Annie came back to talk to Scott one on one to share her story from the Canyons 100.  Hypernatremia is a serious condition and she succumbed to some serious symptoms on the course.  We talk about the experience in hopes to educate other athletes about how to know when you may be at risk.  Annie is such a tough human and we were pumped to have her share the story.  Thanks for listening.

Download for FREE today -  special Mnemonics Cheatsheet - so you can be SURE that you have that Must Know information down:  bit.ly/nursing-memory   Outline MODEL M-Medications / Meals O-Osmotic diuretics D-Diabetes insipidus E-Excessive water loss L-Low water intake Description Think “Salt Modeling Agency” – Use the word MODEL to remember the causes of hypernatremia

Hypernatremia is very commonly tested on all the USMLE exams. If you want to understand the pathophysiology of hypernatremia, this podcast is what you need. I even discuss the reasoning behind why one treatment comes before the other so you’re not just blindly memorizing some algorithm you learnt somewhere. Audio Download

Dr. Alexis "AC" Gomez, a second year fellow in the combined MGH, Brigham and Women's, and Boston Children's nephrology fellowship, continues a discussion of sodium disorders with a conversation about hypernatremia with Dr. Joyce Zhou, a RTL host and internal medicine resident. She shares her approach to high sodium disorders and pearls on diagnostics and management of this disorder. Run the List podcast on AccessMedicine: https://accessmedicine.mhmedical.com/multimedia.aspx#1460

This week, Rob and Zach will be talking about Hypernatremia.We will be discussing the following topics within this episode on Hypernatremia!Introduction to HypernatremiaCauses / PathophysiologyClinical FeaturesPhysical Exam FindingsDiagnosisTreatmentTo follow along with Notes & Illustrations for our podcasts please become a member on our website! https://www.ninjanerd.org/podcast/hypernatremiaFollow us on:YouTube: https://www.youtube.com/ninjanerdscienceInstagram: https://www.instagram.com/ninjanerdlecturesFacebook: https://www.facebook.com/NinjaNerdLecturesTwitter: https://twitter.com/ninjanerdsciDiscord: https://discord.com/invite/3srTG4dngWTikTok: https://www.tiktok.com/@ninjanerdlecturesSupport the show

In de aflevering van vandaag bespreken we alles omtrent hypernatriëmie. Een ondergewaardeerd probleem wat van groot belang is voor het welzijn en overleving van onze patiënt. Is een Natrium vanaf 143mmol/l  al schadelijk?Waarom verhoogd hypernatriëmie het risico op delier?Wat is het effect van hypernatriëmie op de hartfunctie en de beademingsduur?Wat is de behandeling van hypernatriëmie?Wat is het verschil tussen community acquired en IC-acquired hypernatriëmie?Wat is de link tussen hypernatriëmie en mortaliteit?Hoe snel mag je hypernatriëmie corrigeren?Wat is het effect van vrij water toediening?Moeten we wisselen van NaCl 0,9% naar Glucose 5%?- Sodium balance, not fluid balance, is associated with respiratory dysfunction in mechanically ventilated patients: a prospective, multicentre study- "Free water defecit calculation" - MdCalc- Hypernatremia in critically ill patients- ICU acquired hypernatremia treated by enteral free water – A retrospective cohort study- Hypernatremia in the Critically Ill Is an Independent Risk Factor for Mortality- The Development of Intensive Care Unit Acquired Hypernatremia Is Not Explained by Sodium Overload or Water Deficit: A Retrospective Cohort Study on Water Balance and Sodium Handling- Normal saline to dilute parenteral drugs and to keep catheters open is a major and preventable source of hypernatremia acquired in the intensive care unit- Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change- Renal Function is a Major Determinant of ICU-acquired Hypernatremia: A Balance Study on Sodium Handling- Saline versus 5% dextrose in water as a drug diluent for critically ill patients: a retrospective cohort study- Insidious Harm of Medication Diluents as a Contributor to Cumulative Volume and Hyperchloremia: A Prospective, Open-Label, Sequential Period Pilot StudyBedankt voor het luisteren!Volg @intensiefdepodcast op InstagramVragen? intensiefdepodcast@gmail.com

Normal serum sodium levels are 134-145 mmol/L. Hypernatremia is defined as a serum sodium level exceeding 145 mmol/L. Think “fried food is salty”. Hypernatremia can be caused by too much sodium in the blood, but it also is caused by too little free water in the body. You must first assess the patient's volume status before knowing how to treat appropriately. Hypernatremia signs can be very subtle, with changes in the level of consciousness typically being the earliest indicator. Sodium is closely related to blood pressure and blood volume. It is also necessary for muscle and nerve function.

In 2006 Larry and Hannah Overton fell in love with a little boy at their church. His name was Andrew.  Andrew was a foster child that the Overtons felt a great desire to provide a home for and to "become his forever family." He would be their sixth child, an addition to their five biological children.  A few short months later tragedy struck and their world was turned upside down.  Andrew went home to be with Jesus when he passed away from a rare medical condition called Hypernatremia. This condition caused very high, fatal levels of sodium in his body.  This sorrowful tragedy was compounded when Larry and Hannah were accused and charged in Andrews death.  On September 7, 2007 Hannah was convicted of capital murder and sent to a maximum security prison for life without the possibility of parole for a crime she didn't commit. This would leave Larry at home to care for their other 5 children. During Hannah's time in prison God not only held her and her family in His hands but also used this trial in mighty ways.  After seven years of imprisonment, Hannah was exonerated and all charges were dropped on April 8th, 2015. On May 10th, 2017, Hannah was declared actually innocent! During this span, many have come to the Lord and the ministry is continually growing.  Although Hannah is home with her family, Hebrews 13:3 reminds her to "remember those in prison as if you were there with them." She and her husband founded Syndeo Ministries, a non-profit organization focused on helping women who are incarcerated and transitioning out of prison. For more information visit http://www.syndeoministries.comTo follow What's Your Story on Instagram visit http://www.instagram.com/whatsyourstory.podcastHannah Conway is a Lifeway author, a speaker and a women's ministry director in her local church. To connect with Hannah visit http://www.hannahrconway.com or follow her on Social Media:  Facebook: http://www.facebook.com/hannahrconwayInstagram: http://www.instagram.com/hannahrconway_authorStephani Cook is an Enneagram life coach, speaker, podcast host and the creator of On Purpose Coaching. Through On Purpose Coaching she helps others to improve relationships and to discover intentional abundant living. To connect with Stephani or for information about the August 12th On Purpose Live Event visit http://www.stephanicook.org or follow her on Social Media: Facebook: http://www.facebook.com/stephaniscookInstagram: http://www.instagram.com/stephani_cook Cover photo by Alison Weakley Photographyhttp://www.alisonweakleyphotography.comSupport the show

Make your health an act of rebellion. Join The Healthy Rebellion Please Subscribe and Review: Apple Podcasts | RSS Submit your questions for the podcast here News topic du jour: https://www.nytimes.com/2022/05/10/briefing/adolescent-mental-health-crisis-us.html Podcast Questions:   1. Predicting the Future of Food | Bon Appétit [15:55] CT says: Hello Diana and Robb (and teams), I was hoping one or both of you had heard about this article and the concepts it's talking about.  The author references Dr. Morgaine Gaye who pens herself as a food futurologist - though I've no idea what her doctoral title is actually attributable to - and her ideas of Air Protein.  What the heck is this?!  It says that there's a high tech fermentation to turn CO2 into chicken (or whatever you want).  This sounds outrageous, laughable at best to me.  And as Robb always talks about, very carbon tunnel vision.  Was just wondering if you guys could offer your thoughts on this one as I'd never heard of it before nor had I heard of this Dr. Gaye woman and her website was pretty sparse with biographical details. https://www.bonappetit.com/story/plates-of-the-future Love both your podcasts and newsletters.  Robb your substack is great!  Just enough snark and humor which is right up my alley. Diana - I've referenced some of your articles in newsletters to family members asking for nutrition info, it's been so helpful! Keep it up both of you! Cheers, CT 2. What's up with Sunflower Oil in my Fish Oil? [22:59] Bryan: Hi!  Just looking for clarity on the added sunflower oil to the fish oil.  My wife has a nutrition business and we were researching fish oils.  I've followed your stuff for over a decade. Fish oil being a PUFA, inflammatory, added to fish oil doesn't make sense to us other than being a carrier oil or to fill a bottle. Just curious and looking for a good product to refer our clients to with a good conscience. Thanks! Bryan 3. Is this Hypernatremia? [25:51] Cassandra says: Hi Rob and Nickie! My name is Cassandra and I am a 57-year-old woman with lymphocytic colitis, gastritis and intestinal metaplasia. I've been a carnivore for about two years, mostly consuming fatty ribeye with beef tallow . Regardless, my symptoms have flared up considerably. I am also a Personal Trainer of 25 years and work about 60 hours a week. I walk about 15,000 steps a day and lift weights daily for 90 ish minutes. I had done so earlier that day. I have a clear light infrared sauna and I have just gotten up to 150° this past week. Prior to that I've been getting out at 135° -144°. I always use LMNT prior to the sauna, and continue to drink it after the sauna. I only use a quarter to half of the packet as it's too salty otherwise.I use about 10 to 16 ounces of water for half a packet. Yesterday evening I spent about 30 minutes in the hot sauna, and then drank the electrolyte drink afterwards. Because it was late at night I did not notice that I poured the whole packet in before adding water. So as I was drinking the LMNT and the water, it tasted mild as usual but when I got to the bottom a bolus of LMNT swept into my mouth and I swallowed before I could stop it. I didn't think anything of it and went to bed, but a few hours later I was vomiting and severe diarrhea that lasted throughout the night and into this afternoon the next day. I've been tired and weak and unable to work. Did I cause hypernatremia? Thank you for your input. I thoroughly enjoy your podcast   Sponsor: The Healthy Rebellion Radio is sponsored by our electrolyte company, LMNT. Proper hydration is more than just drinking water. You need electrolytes too! Check out The Healthy Rebellion Radio sponsor LMNT for grab-and-go electrolyte packets to keep you at your peak! They give you all the electrolytes want, none of the stuff you don't. Click here to get your LMNT electrolytes Transcript: https://robbwolf.com/2022/05/13/predicting-future-food-sunflower-oil-in-fish-oil-electrolyte-stomach-upset-thrr110/

Chapter 7ReferencesSands JM, Blount MA and Klein JD. Regulation of Renal Urea Transport by Vasopressin. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116377/In this invited piece, Sands and colleagues explain that although urea is permeable across membranes, this is slow, thus urea transporters in the kidney, under control of vasopressin, are needed to facilitate transport and create the medullary gradient. Text book using 20% of extracellular compartment being in the intravascular compartment. https://courses.lumenlearning.com/ap2/chapter/body-fluids-and-fluid-compartments-no-content/ another one: https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book%3A_Anatomy_and_Physiology_(Boundless)/25%3A_Body_Fluids_and_Acid-Base_Balance/25.2%3A_Body_Fluids/25.2B%3A_Fluid_Compartments The chapter I wrote where I went through the math in figure 7-3. It was a major revelation to me: https://docs.google.com/document/d/17BM1xihvlztuQlU8GVNhEDoPLzr6GounHYZAtVUkLvw/edit?usp=sharing Association Between ICU-Acquired Hypernatremia and In-Hospital Mortality https://journals.lww.com/ccejournal/fulltext/2020/12000/association_between_icu_acquired_hypernatremia_and.26.aspx Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients https://pubmed.ncbi.nlm.nih.gov/30948456/ Edelman IS, Leibman J, O'Meara MP and Birkenfeld LW. Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. JCI 1958. This classic paper calculates the total body exchangeable sodium and potassium and establishes the relationship between these. Understanding this painstacking work helps understand the effect of supplementing potassium in the setting of hyponatremia. https://dm5migu4zj3pb.cloudfront.net/manuscripts/103000/103712/cache/103712.1-20201218131357-covered-e0fd13ba177f913fd3156f593ead4cfd.pdfEdelman is the Root of Almost All Good in Nephrology https://www.renalfellow.org/2014/11/20/edelman-is-root-of-almost-all-good-in/ Jens Titze and his team published a pair of articles that shocked those interested in salt and water in JCI in 2017. High Salt intake reprioritizes osmolyte and energy metabolism for body fluid conservation https://www.jci.org/articles/view/88532Increased salt consumption induces body water conservation and decreases fluid intake https://www.jci.org/articles/view/88530in this exciting exploration of the basic assumptions that we hold true regarding salt and water (and staring Russian cosmonauts and an incredible controlled simulation of salt and water intake), Titze shows that high sodium intake does not simply drive water consumption (as we usually teach) but instead leads to a complex hormonal and metabolic response (even with diurnal variation!) and results in body water conservation and decreased water consumption. And accompanying editorial from Mark Zeidel: salt and water, not so simple. https://www.jci.org/articles/view/94004In addition, Titze and others have done interesting work on sodium deposition in tissues where it may also be a source for systemic inflammation.https://pubmed.ncbi.nlm.nih.gov/28154199/Jens Titze talking about salt, water, thirsting a TEDx talk. https://www.youtube.com/watch?v=jQQPBmnIuCY A discussion/debate of the overfill vs. underfill theory of edema in the nephrotic syndrome (hint- overfill theory triumphs) would be incomplete without a reference to congenital analbuminemia. This reference from Frontiers in Genetics explores the diagnosis, phenotype and molecular genetics and reveal that patients tend to have only mild edema but severe hyperlipidemia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478806/The finding that proteinuria can directly lead to sodium retention based on a study when puromycin aminoglycoside induced proteinuria of one kidney lead to sodium retention by that kidney which was localized to the distal nephron. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC436841/?page=9Plasmin may be the culprit at the level of the epithelial sodium channel based on Tom Kleyman's work: https://jasn.asnjournals.org/content/20/2/233Amiloride may help! (stay tuned for amiloride in a future episode) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016639/An old favorite of JC's from the Kidney International feature which debates the cause of edema in the nephrotic syndrome.https://www.sciencedirect.com/science/article/pii/S0085253815583075Under protest, we hobbled through a discussion of the Gibbs Donnan affect even encouraged by one of Amy's fellows based on this article from QJM: https://academic.oup.com/qjmed/article/101/10/827/1520972 suggesting that our understanding of the role of hyponatremia in fractures might be all wrong- it could be related to hypoalbuminemia.

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This is why I love Latin... for the depth it gives to language in general. We go over the terms: Hypernatremia, Hyponatremia, Hypothermia, Hyperglycemia, Hypoglycemia, Armistice and Subpoena. Here we understand the importance of prefixes, affixes, suffixes, etc. I swear... If you think Latin is dead... You've just been proven wrong. Thanks and goodbye to antiquated thinking! --- Support this podcast: https://anchor.fm/liam-connerly/support

An overview of hypernatremia from typical presentations of Hypernatremia to acquired hypernatremia and associated treatment options. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/andrew-kowalski/support

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat and I'm Rahul Damania and we are coming to you from Children's Healthcare of Atlanta - Emory University School of Medicine. Welcome to our Episode of a 9 year old girl with worsening seizures in the setting of an electrolyte abnormality. Here's the case: A 9 year old girl presents to the ED with increased frequency of seizures, dehydration and listlessness. She has h/o of global developmental delay, congenital hydrocephalous (with VP shunt in place with her last revision 3 years prior, and seizure d/o treated with Leviteracetam. She usually has one or two focal seizures per day but on day of admission she had multiple prolonged seizures which were also generalized tonic clonic in semiology. Per her caregiver, the patient usually eats by mouth and mother typically gives her 3 cups of water daily. There is no history of diarrhea but patient has had 2-3 bouts of non-bloody non-bilous emesis on day of presentation. Looking at her growth chart, the patient has also lost ~ 2KG of her weight in the last 3 months and has had poor follow up with her PCP. In the ED she has a hypovolemic shock picture as she is hypothermic, tachycardic, tachpneic, and hypotensive with appropriate saturations. Blood gas is notable for a mild metabolic acidosis. Patient receives abortive seizure rescue. A head CT showed no increased in hydrocephalus, no mass or hemorrhage and a shunt series confirms patency of her VP shunt. Most pertinently to this case, her serum sodium on her RFP was undetectable at a value of = >200mEQ/dL; this was confirmed by a repeat lab draw and POC value. Other notable findings included an elevated Cr for age, an elevated BUN and a microcytic anemia. Patient was given a NS bolus, had cultures drawn, was started on broad spectrum abx therapy, stabilized and sent to the PICU. To summarize key elements from this case, this patient has: A history of GDD with epilepsy and shunted hydrocephalus. A stigmata of cachexia. And a presentation of hypovolemic shock secondary to decreased intake, increased loss, and potential underlying concern for sepsis. The most important element of this case is her extreme hypernatremia All of these factors in this case point to our topic of discussion today → the approach to hypovloemic hypernatremia 2/2 to dehydration. Let's transition into some history and physical exam components of hypovolemic hypernatremia? Key history features in patients who present with Hypovolemic HyperNa include: Increased losses such as emesis Decreased intake, and in this setting potentially lack of access to free water Listlessness which could be related to cerebral hypoperfusion Increase in seizure frequency due to increased rapid depolarization of Na channels in the brain and fluid shifts And weight loss → all of these factors were seen in our case. Of note if this patient was a neonate considering a high-pitched cry in the setting of hyperNa & dehydration could be a subtle history finding. Are there some red-flag symptoms or physical exam components which you could highlight? Our patient is Non verbal and has global delay secondary to a remote neurological insult She may not have intact ability to communicate or vocalize thirst. Apart from her mucous membranes, dry cracked lips, decreased skin turgor that can be described as doughy, and prolonged capillary refill, I think it is important to highlight her hypotension - as BP is one of the last vital signs in pediatrics to be abnormal in intravascular volume depletion. To me, this really stratifies this patient into severe dehydration and potentially septic shock. This is a great point — understanding % volume loss and its correlation to vital sign and PE anomalies is key. Remember a sensitive marker for dehydration in pediatrics is tachycardia and a late finding if you are primarily dealing with dehydration is hypotension. This indicates...

A new study in The Journal of Clinical Endocrinology & Metabolism shows the relationship between abnormal sodium levels and greater risk of respiratory failure and death in patients with COVID-19. Host Aaron Lohr speaks with two of the authors, Ploutarchos Tzoulis, MD, PhD, from University College London Medical School and Julian Waung, PhD, from the Whittington Health NHS Trust in London. For more information, including helpful links and other episodes, visit our website at https://www.endocrine.org/podcast

A new study in The Journal of Clinical Endocrinology & Metabolism shows the relationship between abnormal sodium levels and greater risk of respiratory failure and death in patients with COVID-19. Host Aaron Lohr speaks with two of the authors, Ploutarchos Tzoulis, MD, PhD, from University College London Medical School and Julian Waung, PhD, from the Whittington Health NHS Trust in London. For more information, including helpful links and other episodes, visit our website at https://www.endocrine.org/podcast

A new study in The Journal of Clinical Endocrinology & Metabolism shows the relationship between abnormal sodium levels and greater risk of respiratory failure and death in patients with COVID-19. Aaron speaks with two of the authors, Ploutarchos Tzoulis, MD, PhD, from University College London Medical School and Julian Waung, PhD, from the Whittington Health NHS Trust in London. For more information, including helpful links and other episodes, visit our website at https://www.endocrine.org/podcast

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Shawn, who is an MPH, LDN, RD, CISSN, FISSN, is a leading nutritional biochemist and expert on health optimization. He has formulated over 500 supplements, foods, beverages, and cosmeceuticals, has patented 10 novel ingredients, and is now known as the Ingredientologist—the scientist of ingredients. Formerly a chief clinical dietitian with over a decade of clinical experience, he has counseled thousands of people on natural health solutions such as keto, paleo, fasting, and supplements. He has also personally overcome various health issues including Epstein-Barr virus, chronic fatigue syndrome, fibromyalgia, depression, insomnia, obesity, and a pituitary tumor. As a world-renowned thought leader on mitochondrial health, he has been paid to speak on five different continents. His insights have been prominently featured in documentaries, nationally syndicated radio programs, and regularly on morning television. Shawn's expertise can help any health-conscious individual to better manage stress and experience higher performance and more energy through utilizing his practical research-backed solutions. During this discussion, you'll discover: -What Shawn had for breakfast the day of the interview...7:11 He was 40 hours into a 72-hour fast 36 to 48 hours into the fast is when he starts to feel amazing Pique fasting tea Redmond Real Sea Salt Redmond Re-Lyte Electrolyte Drink Mix Hypernatremia, and why slight dehydration isn't a bad thing for performance...9:40 Hypernatremia: not enough sodium in the blood Athletes are not only more hypernatremic than dehydrated, but usually both Electrolyte formulas are fine, but more salt is lost while sweating Keto dieters tend to be hypernatremic Hunger and headaches may be a sign of hypernatremia rather than a lack of water Redmond Real Salt (contains trace minerals, family-oriented company) Real salt tested low in contamination (no anti-humectant added to dry out the salt) Celtic Sea Salt (recommended by Robert Slovak) Ben's morning hydration regimen: Adds Quinton Hypertonic Minerals to well water from his property Vitamin C 2:1 ratio to baking soda Water and Wellness hydrogen tablets BGF podcasts on deuterium depleted water Deuterium Demystified: Everything You Need To Know About Deuterium Depleted Water (DDW), How To Lower Deuterium & Much More, With Dr. Ann Cooper And Dr. Que Collins. Water & Water Filtration: Everything You Need To Know About Water Filters, Alkaline Water, Structured Water, Hydrogen-Rich Water, Deuterium-Depleted Water & Much More, With Robert Slovak. Why The War On Cancer Has Failed & What You Can Do About It: Mistletoe, NAD, Deuterium Depleted Water, Melatonin, Gerson Therapy & Beyond, With Dr. Thomas Cowan Vape Pens, Hair Growth Serums, Fixing The Pineal Gland & C60 (The Next Great Longevity Molecule), With Ian Mitchell. H2Bev hydrogen water in a can (use code BEN to save 10%) Avoid glyphosate like the plague (Roundup) -Optimizing glutathione levels for optimal mitochondria...21:35 Mitochondrial glutathione is the main line of defense against cell death; prevents impairment of the electron transport chain N-Acetylcysteine (NAC) is one of the best ways to boost glutathione AlmsBio Mitotherapy, with PQQ and COQ10 (use code BENGREENFIELD10 to save 10%) Bioadvantex's PharmaNAC Thorne NAC (what Shawn uses) -The criteria by which Shawn evaluates a supplement brand...25:30 Contract manufacturing is in some ways better than in-house Thorne, Standard Process, Pure Encapsulations invest heavily in quality control BioTrust spent 2 years working on a formula with Shawn The Nitty-Gritty Underground World of Supplement Ingredients, Sports Nutrition Frankenfuels, Illegally Laced Compounds & More, With Shawn Wells. You get what's on the label, and you don't get what's not on the label A little bit more pricey, but you're paying for that quality Beware of vegetable oils or "proprietary blends" Companies use the leaf or stem in their product when they should be using the root Gingko has to be the leaf; ginseng has to be the root -How Shawn discovered two substances and made them into supplement form...35:45 Theacrine and Dynamine™ Worked with Dr. Hector Lopez and Dr. Tim Ziegenfuss Methylliberine (Dynamine™) In the methylxanthine family (of which caffeine is a part) Enhanced energy and focus Pain reduction Stimulated NAD production No habituation effect as you find in caffeine Less adaptation effect Biggest difference is the half-life Infopathy generator (use code BENG10 for 10% off) (Ben's podcast with Anton Federenko will be published on February 27) Hapbee wearable Theacrine and Dynamine™ are full synthetic (GMP and informed-choice tested for sports - tested athletes can use it); natural extraction is cost-prohibitive, but it does occur naturally in tea leaves and cacao Shawn's energy stack: Creatine Dynamine™ Alpha GPC -The exercise augmenter that has been called "exercise in a bottle"...44:15 Advanced Smart Drugs & Nootropics You’ve Never Heard Of, Rare Japanese Seaweed For Sleep Enhancement, The Most Powerful Form Of Vitamin B1 That Exists & Much More! With Lucas Aoun. Ergogenic Health β-aminoisobutyric Acid - L-Baiba is an exercise mimetic (exercise augmenter) Intense exercise breaks down BCAA muscle pool to use those amino acids for fuel for the workout L-Valine ends up converting into L-Baiba Mitoburn (L-Baiba) Positive things associated with exercise are enhanced when L-Baiba levels are increased in plasma Brown adipose tissue is brown because of the amount of iron; it's more mitochondrially dense (only 2% or so in your body); burns fat like nothing else Babies can't shiver until about 6-9 months to create heat thermogenesis; we have brown adipose tissue for that reason It is around your collarbone because that's your core; it's important to keep heat near your core More brown adipose tissue may be a factor in one's metabolism -Grains of paradise...49:55 Grains of paradise is a type of pepper, gingery taste; similar to capsaicin and ginger Enhances metabolism without a stimulant effect 40mg increased thermogenesis and caloric expenditure of around 100 calories a day -Ben's super easy goals for his upcoming 40th birthday...52:15 Humans are the easiest to kill in all of history Goldilocks zone - just the right amount of hormetic stressors Polyphenols are xenohormetics to plants "Strong people are harder to kill than weak people—and more useful in general." Why Strong People Are Harder To Kill (And How To Get Strong), With Keith Norris. Ben's 40th birthday activity: complete in a 40 hour fasted state: 2-3 rounds of Wim Hof breathing leading up to a 4-minute static breath-hold 1 40 kg kettlebell Turkish get-up per side 4-minute dead hang from a bar  400-meter farmer's walk with a kettlebell in each hand (40kg) 4-minute ice bath at 32°F (use code BENFORGE to save $150 off any Forge) -A different form of berberine that is used to control blood glucose levels...56:30 A Rocket Scientist Homeschooler’s Insider Blood Glucose Monitoring Secrets, The Best Way To Use A Continuous Glucose Monitor (CGM), Blood Sugar Biohacking Tips & Much More, with Josh Clemente of Levels Health Dihydroberberine Consuming berberine at the gut level converts it to dihydroberberine; at the plasma level it is converted back to berberine Berberine is a glucose disposal agent Dihydroberberine is Shawn's number 1 recommended anti-aging ingredient 5x more bioavailable than berberine, and lasts around twice as long Doesn't give you GI distress that you get berberine Mitochondrial hormetic -Shawn's new formula for BHB and thoughts on exogenous ketones...1:03:30 HVMN ketone ester Ketone Aid Patent on active isomer RBHB (aka DBHB) Exogenous ketones can carry excess minerals; causes some GI distress All in powder form, very salty in taste -Preferred medium-chain triglycerides (MCTs) to go with ketones...1:07:00 Caprylic acid (C8) is best for increasing ketones Lauric acid is great as a virucidal and anti-bacterial; monolaurin for the immune system Dom D'Agostino has a patent pending (ketone + C8) Which Ketone Supplement Works Best: Ketone Salts vs. Ketone Esters With Dr. Dominic D’Agostino. -The best way to raise NAD levels...1:09:20 NMN (use code GREENFIELD10 to save 10%) is better than NR Ben Greenfield Interviews Dr. David Sinclair About Lifespan: Why We Age―and Why We Don’t Have To. Intranasal supplements (use code BEN to save 5%) are often administered incorrectly Getting a quality NMN and the correct amount Fisetin, NMN, apigenin the ultimate stack Add in COQ10 and PQQ for the ultimate mitochondrial stack Article by John Lieurance: Mito Fast: A Brand New Advanced Anti-Aging Protocol To Nurture Your Mitochondria, Boost Autophagy, & Rejuvenate Your Stem Cells.  Iontophoresis NAD patches -And much more! Resources from this episode: - Shawn Wells: The ENERGY Formula: Six Life Changing Ingredients to Unleash Your Limitless Potential The Nitty-Gritty Underground World of Supplement Ingredients, Sports Nutrition Frankenfuels, Illegally Laced Compounds & More. - Podcasts and article: Deuterium Demystified: Everything You Need To Know About Deuterium Depleted Water (DDW), How To Lower Deuterium & Much More, With Dr. Ann Cooper And Dr. Que Collins. Water & Water Filtration: Everything You Need To Know About Water Filters, Alkaline Water, Structured Water, Hydrogen-Rich Water, Deuterium-Depleted Water & Much More, With Robert Slovak. Why The War On Cancer Has Failed & What You Can Do About It: Mistletoe, NAD, Deuterium Depleted Water, Melatonin, Gerson Therapy & Beyond, With Dr. Thomas Cowan Vape Pens, Hair Growth Serums, Fixing The Pineal Gland & C60 (The Next Great Longevity Molecule), With Ian Mitchell. Advanced Smart Drugs & Nootropics You’ve Never Heard Of, Rare Japanese Seaweed For Sleep Enhancement, The Most Powerful Form Of Vitamin B1 That Exists & Much More! With Lucas Aoun. A Rocket Scientist Homeschooler’s Insider Blood Glucose Monitoring Secrets, The Best Way To Use A Continuous Glucose Monitor (CGM), Blood Sugar Biohacking Tips & Much More, with Josh Clemente Which Ketone Supplement Works Best: Ketone Salts vs. Ketone Esters With Dr. Dominic D’Agostino. Ben Greenfield Interviews Dr. David Sinclair About Lifespan: Why We Age―and Why We Don’t Have To. Why Strong People Are Harder To Kill (And How To Get Strong), With Keith Norris.Mito Fast: A Brand New Advanced Anti-Aging Protocol To Nurture Your Mitochondria, Boost Autophagy, & Rejuvenate Your Stem Cells. - Food and supplements: Pique Tea Redmond Real Sea Salt Redmond Re-Lyte Celtic Sea Salt Quinton Hypertonic Vitamin C Baking Soda Water and Wellness Hydrogen Tablets H2Bev (use code BEN to save 10%) NAC AlmsBio Mitotherapy (use code BENGREENFIELD10 to save 10%) Bioadvantex's PharmaNAC Theacrine Dynamine™ Infopathy (use code BENG10 for 10% off) Creatine Alpha GPC L-Valine Mitoburn (L-Baiba) Grains of Paradise Dihydroberberine Berberine HVMN Ketone Aid Caprylic Acid (C8) Monolaurin NMN (use code GREENFIELD10 to save 10%) Nicotinamide Riboside NeuroNAD Intranasal Spray (use code BEN to save 5%) Fisetin Apigenin COQ10 PQQ NAD Patches - Other resources: Hapbee Wearable Kettlebell Morozko Forge (use code BENFORGE to save $150) Wim Hof Breathing Methylxanthine Turkish Get-up Video Dead Hang Video Farmer's Walk with a Kettlebell Video Episode sponsors: -Kion Coffee: Carefully selected and roasted for taste, purity, high antioxidants, and health. BGF listeners save 20% off your first order with code BGF20. -Chili Technologies: ChiliSleep makes both the chiliPAD and OOLER, innovative options that fit over the top of your mattress and use water to control the temperature of your bed and help lower your core body temperature to trigger deep, relaxing sleep. -Paleovalley Beef Sticks: 100% grass-fed AND grass-finished. Keto friendly and higher levels of Omega 3 Fatty Acids. Receive a 15% discount on your order when you use my link. -Butcher Box: Delivers healthy 100% grass-fed and finished beef, free-range organic chicken, and heritage breed pork directly to your door on a monthly basis. All their products are humanely raised and NEVER given antibiotics or hormones.  -Spiritual Disciplines Journal: The new Spiritual Disciplines Journal by Ben Greenfield is coming soon! Sign up to download a free preview and get notified once it's ready. Do you have questions, thoughts, or feedback for Shawn or me? Leave your comments below and one of us will reply!

This session talks about the basics of the different electrolyte imbalance for Sodium i.e. Hyponatremia & Hypernatremia, with its pathophysiology, investigation to perform, treatment offered in Modern Medicine. Do Listen podcast, will help to increase the overall knowledge and better understanding of disease condition. I am here to spread a bit of knowledge that I have gained regards to MEDICINE. Do share my podcasts with your friends and colleagues, and join in to spread this knowledge and learn. Thank you for listening.

This episode covers hypernatremia!

This episode covers hypernatremia!

Sarah, Callum and Karen jump on Zoom for a salty chat on all things sodium! Join us as we delve into hypOnatraemia, hypERnatraemia, even diabetes insipidus! This ep is peppered with mnemonics!

Dr. Fabio Nascimento discusses an article from the Neurology Resident and Fellow section entitled, "Neurology: Extrapontine Osmotic Demyelination in Hypernatremia". Show references: https://n.neurology.org/content/94/16/e1780

Episode Description Dr. Julia Burns presents a Human Dx unknown to Sharmin and Mercy residents  – Drs. Brady Alling and Aaron Sabal. Download CPSolvers App here Patreon website Human Dx case Dr. Brady Alling Brady is a PGY 3 at Mercy Health in Muskegon, MI. Next year, he will be doing a fellowship in pulmonary &… Read More »Episode 95: Human Dx unknown with Sharmin & Mercy residents – Hypernatremia

These are my notes based on sodium balance that we have gone over in Med-Surg

Arseny Chernov is the founder of Food Buddy an endurance nutrition coaching company and has a diploma of nutrition science as well as being an ironman athlete and tech professional.Engage with Foodbuddy on https://instagram.com/foodbuddy or https://fb.me/foodbuddyMentioned the following:• Estimated Energy Requirement Calculator: http://bit.ly/foodbuddy-eer• Conrad P. Earnest, Jeff Rothschild, Christopher R. Harnish & Alireza Naderi (2019) Metabolic adaptations to endurance training and nutrition strategies influencing performance, Research in Sports Medicine, 27:2, 134-146, DOI: https://doi.org/10.1080/15438627.2018.1544134• Rothschild JA, Bishop DJ, Effects of Dietary Supplements on Adaptations to Endurance Training, Sports Med. 2019 Sep 17, DOI: https://doi.org/10.1007/s40279-019-01185-8• Supplement for 100+ km/week joints running load: http://bit.ly/foodbuddy-geladrink• Inspiring Book: Throwing Rocks at the Google Bus https://amzn.to/34fuqUs• Inspiring Book: iGen: Why Today's Super-Connected Kids Are Growing Up Less Rebellious https://amzn.to/2JC1n5v• Inspiring Book: 80/20 Running: Run Stronger and Race Faster by Training Slower https://amzn.to/2NtNLKJ• Best sub-100$ thing: coaching by Merle Talviste, https://www.swimsmoothsingapore.com/squad• Best sub-100$ thing: Injini 2.0 Toe-socks https://amzn.to/2L4FyuY , Drymax socks: https://amzn.to/2QjXAiKTell us about your background in nutrition and history in endurance sports. What came first?Went from ~110 kg 80 kg myself. 10h 39min in Ironman Cairns (140.6), 29h 18min in PYT166 100-miler with 8000 meters elevation. Got a lab coat - did a Specialist Diploma in Nutrition Science at NYP Singapore, on top of my Master Degree in technology. I launched my own app for iOS called FoodBuddy, sunsetting it now unfortunately.My wife Lily's fully recovered from the neck disc tear through nutrition and well-being planned. Now runs duathlons.Foodbuddy is all about coaching 1x1, enterprise workshops (most impactful format), also present in Regional Committees (RC-s) in Singapore as I'm a People's Association Trainer.Standard Chartered Singapore Marathon 2018 official nutrition coach, run workshops, Facebook live-s.My mentors: Andre Blumberg, Matt Fitzgerald. Coached in “kampung spirit” of Integrated Riding Racing Team (IRRT) - takes a village to ride fast! Kudos to Merle Talviste (Swim Smooth coaching Singapore)Tell us about your philosophy on nutritionNutritional choices (what to take) is NOT diet (sum of intake). Let's get terms right. Most important aspect is Hunger vs. Appetite. Figure your Estimated Energy Requirement: http://bit.ly/foodbuddy-eer Set yourself up for the reality around you. Then get bored! How I pre-select to fight appetite. Recipes. Patterns.VICE uploaded “Mac & Cheese for 17 years” - “I've tried celery. I threw that shit out instantly” - https://www.youtube.com/watch?v=v1TWvXwgKr0 .Crazy case of some nervosa, definitely not anorexia nervosa though.Anyways, it's ABCD - no single right answer! Nutritional Needs Assessment uncovers it:● Anthropometric (i.e. BMI %%-s, fat loss progress, )● Biochemical (nutrient deficiencies, cholesterol level, OGTT for Diabetes)● Clinical (skin state, etc.)● Dietary (ecological / social status, certain food restrictions due to religion, food log, habits)As to athletes… aspiring vs. amateur, let's be real.● Eliud Kipchoge - Maurten hydrogel 2018, 2019. By the way there's a study that it's not really working as it's supposed to?.. Well, it works for Eliud anyways.● Chris Froome - haribo gummy candies in Giro D'Italia 2018 while losing 1 kg over 5 days.So did Peter Sagan.For us, ex-hunters with 10,000-s of years of experience, - everything edible is great in moderation.There are lots of diets that endurance athletes follow from Vegan, to Paleo to HCLF to Full Keto. What do you believe is the ideal diet for endurance sportsSuccessful event is a factor of preparation, mental health, in-race nutrition, luck (i.e. weather). Successful result is equivalent to “high performance”. High performance usually means lower mass.There's a new movie about vegan diet that throws in a bunch of claims by the way:● “Roman gladiators didn't eat meat” - that's an anecdote from archaeologist, Andrew Curry, in Archaelogoly Magazine 2008: Karl Grossschmidt of Medical University of Vienna, Vienna (MedUni Vienna). Gladiators, it seems, were fat. Consuming a lot of simple carbohydrates, such as barley, and legumes, like beans, was designed for survival in the arena. Packing in the carbs also packed on the pounds. "Gladiators needed subcutaneous fat," Grossschmidt explains. "A fat cushion protects you from cut wounds and shields nerves and blood vessels in a fight." Not only would a lean gladiator have been dead meat, he would have made for a bad show. Surface wounds "look more spectacular," says Grossschmidt. "If I get wounded but just in the fatty layer, I can fight on," he adds. "It doesn't hurt much, and it looks great for the spectators."● Claim “on par”. Plants could be an extremely good source of protein if all 9 essential amino acids + Nitrogen containing amino acids, but to say that it is on par with animal protein in terms of minerals like iron, vitamins like creatine, and synthesis availability (which are incredibly important for high performing athletes) is an outright BS.For vegetarians, it is important to know that Protein Quality = Amino Acid Composition + Digestibility (soy is best, up to 90% where 100% is meat)Beef is less than egg whiteI eat eggs and drink milk = top PQ food :-) therefore, are you ovo-lacto-vegetarian :-)Complementary: legumes + grains (different amino-acids).Biological Value = (nitrogen retained, g / nitrogen absorbed, g) * 100Higher = better matchLower = lower matchFAT content in meat is higher, yes. There are two types of fat absorption: for saturated fat it's through lymphatic system (chylomicrons, leading to LDL) and through intestine walls then venes and to liver (for unsat / polyunsat). Former flies past the adipose tissue reserves through lymphatic system, resulting in subcutaneous fat refills uncontrolled. Latter is controllable but again, there are two vehicles that can be determined using biochemical blood test -- High Density Lipoproteins (HDL) GOOD lipoprotein -- very small size, Low Density Lipoprotein (LDL) BAD as can potentially clog the arterias.LCHFRothschild JA, Bishop DJ, Effects of Dietary Supplements on Adaptations to Endurance Training, Sports Med. 2019 Sep 17, DOI: https://doi.org/10.1007/s40279-019-01185-8 (shout out, he's in New Zealand doing his PhD)Over the past 20 years, research suggested that strategically reducing carbohydrate (CHO) availability during an athlete's training can modify the metabolic responses in lieu of simply maintaining a high CHO diet. Several methods have been explored to manipulate CHO availability and include: Low-carb, high-fat (LCHF) diets, performing two-a-day training without glycogen restoration between sessions, and a “sleep-low” approachArguments in favor of trying to increase fat-burning capacity focus around the ability to utilize the large stores of endogenous lipids found even in very lean athletes, while preserving the relatively limited supply of muscle and liver glycogen. Yet despite this theoretical advantage, measurable performance improvements from deliberately increasing fat burning capacity have been elusive.Each of these methods can confer beneficial metabolic adaptations for the endurance athlete including increases in mitochondrial enzyme activity, mitochondrial content, and rates of fat oxidation, yet data showing a direct performance benefit is still unclear.Do you believe in strict macros or simply calories in calories outThey all converge to one another, if you do it right. Estimated Energy Requirements (EER) is key here, and think about 7 days sliding windos.Another way to think about food is through the portions count of a particular quality. Kind of Matt Fidzgerald's approach. Know your EER + tweak PAL. Think last 7 days window. Control thirst-induced hunger. Eat breakfast like a pro.How do you believe the diet differs for each endurance sportEverywhere it's Gravity. Gravity is mass. Mass also non-linear to skin area, there's a formula to that. Thus the more mass - the more heat-induced stress from energy production, but not proportionally enough evaporation. Fat % reduction vs. temperature range vs. VO2max. Same stuff.What is your philosophy on nutrition during raceDepends on the race. Drink by thirst, do not fall below, do Protein.What is your philosophy on nutrition in recoverySleep. Compensation vs. recovery. DOMS. Antioxidants. Orange, Lime, Strawberries. Guava.Protein ratio to Carbohydrates. 30% of EER means ~0.8g/kg/day . Increase with intensity. Don't compensate!I do collagen peptides for 100+ km weeksHow do you feel about fasting as a method for endurance athletes.Time restricted eating and longer term fastsExercise more! Ride up grades, don't buy upgrades!What about alcohol? Red wine good / bad? Volume?7 cal/g, balance with life.Do you recommend protein shakes?Depends on training volume, but the the NuZest is great.What about supplements? Vitamins, minerals, fish oils? Do you recommend and how do you suggest people review which supplements they should get. I've done DNAFit which showed a genetic lack of B6 and B12Do the Clinical blood test and talk to doctor. Sleep.I do collagen peptides for 100+ km weeksDrinking during endurance sports? Hypernatremia is a big risk. Do you suggest taking on salt during exercise.Comrades Marathon study by Tim Noakes, author of “Waterlogged”. Water follows electrolytes, salt inhibits the water. Same in inter-cellular and intracellular. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564296/Are there any ‘superfoods' which you recommend, Apple cider vinegar, Flak seeds, Chia seeds, nuts.Train more!Chia is great brekkie, keeps the Latin American economy going as side-effect ;-)“PROTEIN DIGESTIBILITY OF CHIA SEED Salvia hispanica L” -- digged through faeces to find out.CHIA SEE contains 18% of protein content, a level markedly greater than other nutritional grains such as wheat (14%), corn (14%), rice (8.5%), oats (15.3%) and barley (9.2%) -- grind in to flour or buy as powder.Fiber content. And it's cool :-) But, low protein digestibility according to FAO/OMS (42) standards. 79.80%Raw seed only 34% It looks like grinding would help protein digestion of raw seed. This treatment improve digestibility that could happen due to the fact that grinding divide and expose all seed component allowing enzymes actions. Finally, soybean flour shows an intermediate digestibility score, which is in concordance with previously a report.BEETROOTConrad P. Earnest, Jeff Rothschild, Christopher R. Harnish & Alireza Naderi (2019) Metabolic adaptations to endurance training and nutrition strategies influencing performance, Research in Sports Medicine, 27:2, 134-146, DOI: https://doi.org/10.1080/15438627.2018.1544134The limited evidence suggests there may be small but favourable effects of endurance training with nitrate supplementation, which are possibly related to changes in muscle fibre type. Beetroot juice may be more effective than nitrate salts, though the eficiency of supplementation can be affected by inter-individual variability [97] and environmental conditions [98]. All studies to date have used high-intensity training protocols, as dietary nitrate is particularly effective at augmenting physiological responses in type II fibresSugar, is it really the enemy?Yes. Dopamine! Not good :-(Meat, is it really the enemy?Often high fat in meat, plug cooking with oil... But again, it's vs. choices, vs. tastes, vs… Well, for protein - nothing beats egg whites. You choose!Around your endurance athlete CV. How many IronMan have you run. What was your best performance?PB 10:39 in Cairns 140.629:18 in PYT166Have you ever DNFd? What's your favourite DNF and why? What did you learn?NopeWhat makes you emotionalMusic, good movies. Watched “Big” with Tom Hanks recently, what a great movie. Endorphins from meditative trail running.Most inspirational bookiGen by Jean Twenge / Crucial Conversations by Al Switzler / Throwing Rocks at Google Bus Douglas Rushkoff / 80/20 Running by M.FitzgeraldFavourite podcastsUnfortunately I'm the audiobooks kind of guy at best :-( Will do more Endurance Asia!Favourite endurance tech appsStrava of Alan Bradley :-) RAAM Solo, now RedBul TransSiberian... and being Friends on Facebook with Jag Lanante and Andre Blumberg.Best kit you've bought under $100• Best sub-100$ thing: coaching by Merle Talviste, https://www.swimsmoothsingapore.com/squad• Best sub-100$ thing: Injini 2.0 Toesocks https://amzn.to/2L4FyuY , Drymax socks: https://amzn.to/2QjXAiKProudest moment personal / physical / professionalMy daughter. My wife's recovery from neck disc tear.Closing remarks advice anyone thinking of coming up with or doing a challenge, whether it be a expedition adventure race, ironman, ultra marathon or Everest..Set goals, look backwards, imagine, visualize, and think backwards how to get there. Always neg-split. Always set interim achievable goals!Engage and reach out on Social media :-)

Emily Gutowski interviews Dr. Ankit Patel about the workup and management of a patient with hypernatremia. They break down this complex problem into four simple categories and work through the treatment of patients with elevated sodium levels. www.runthelistpodcast.com/nephrology/#hypernatremia Click here for this episode's handout: http://bit.ly/hypernatremia_pdf

Solve hypernatremia with tips and tactics from Dr. Joel Topf, MD (@kidney_boy), our Kashlak Chief of Nephrology. We review the diagnostic workup for hypernatremia, polydipsia and polyuria, review the pathophysiology of diabetes insipidus, and how to differentiate between nephrogenic and central DI. Plus, we walk through how to treat hypernatremia in the acute setting and Dr. Topf shares clinical pearls on why hypernatremia is the opposite of hyponatremia… It’s easy! Full show notes at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written by Hannah R. Abrams and Joel Topf MD Producer: Hannah R. Abrams Cover Art and infographic by: Hannah R. Abrams Hosts: Hannah R. Abrams; Stuart Brigham MD; Matthew Watto MD, FACP Editors: Matthew Watto MD, FACP; Emi Okamoto MD  Guest: Joel Topf MD Check out Dr. Topf’s podcast! The NephJC podcast, Freely Filtered, discusses the latest NephJC topic every two weeks. Subscribe here or on iTunes.  Time Stamps 00:00 Intro, disclaimer, guest bio 03:25 Joel’s one liner and plug for his new podcast 05:34 Hannah shares a really weird analogy 07:10 Picks of the week*: In Shock (book) by Rana Awdish; HBO’s From the Earth to the Moon; Once Upon a Time in Hollywood (film); Glass(film) directed by M. Night Shyamalan (Stuart’s anti-pick)POCUS! Sign up for a course today from the ACP, AIUM or TRUST.  13:18 Why hypernatremia is easy 14:49 The case of Paula Uric - new onset hypernatremia with hypercalcemia 16:12 Hypernatremia risk factors; ADH, osmolality and the kidney  21:20 Loop of Henle and the sodium, potassium and 2 chloride channel 22:05 How hypercalcemia mimics nephrogenic diabetes insipidus 29:30 Hypercalcemia workup 33:10 Differentiating central from nephrogenic diabetes insipidus 37:35 DDAVP, desmopressin and treatment of nocturia 38:50 The case of Manny Uric - altered mental status and hypernatremia Na = 162; Why do patients in the ICU develop hypernatremia? 42:29 Calculate the fluid deficit; total body water 48:05 Estimate insensible losses (electrolyte free water clearance) 54:48 What if your hypernatremic patient is also hypovolemic? 57:30 Does fluid restriction work in heart failure? 58:35 Hypernatremia - Is there such a thing as too fast in adults?  63:44 Thiazides versus acetazolamide for nephrogenic DI 68:34 Take home points 71:20 Outro Links* In Shock (book) by Rana Awdish HBO’s From the Earth to the Moon Once Upon a Time in Hollywood (film) Glass (film) directed by M. Night Shyamalan (though consider avoiding, per Stuart) POCUS! Sign up for a course today from the ACP, AIUM or TRUST *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures Dr Topf lists the following disclosures on his website: “I have an ownership stake in a few Davita run dialysis clinics and a vascular access center. Takeda Oncology made a donation to MM4MM the program that is taking me to Mount Everest in 2018”. The Curbsiders report no relevant financial disclosures. Citation Topf J, Abrams HR, Brigham SK, Okamoto E, Watto MF. “170 Hypernatremia is Easy with Joel Topf MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. September 2, 2019.

Hyponatremia and hypernatremia are common in ICU patients and they are associated with increased morbidity and mortality. In this episode of Critical Matters, we discuss the diagnostic approach and treatment of sodium disorders in the ICU. Our guest is Dr. Lawrence Weisberg, Head of the Division of Nephrology and Deputy Chair of Medicine at Cooper University Health Care. Dr. Weisberg is also Professor of Medicine and Assistant Dean for Curriculum at the Cooper Medical School of Rowan University, in Camden, New Jersey. Additional Resources: Disorders of Plasma Sodium - Causes, Consequences, and Correction: https://bit.ly/2TT9SNB Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients: https://bit.ly/2P2wxrY Evidence for Managing Hypernatremia: Is It Just Hyponatremia in Reverse?: https://bit.ly/2HjZn0S Books Mentioned in this Episode: From Fish to Philosopher; the Story of our Internal Environment by Homer William Smith: https://amzn.to/30nrraU Operating Manual for Spaceship Earth by R. Buckminster Fuller: https://amzn.to/2Z6coWt Critical Path by R. Buckminster Fuller: https://amzn.to/2MA9vH9

Joel TopfJennie LinMatt SparksSamira FaroukThe strange story of Jennifer Strange.https://insiderexclusive.com/radios-deadly-stunts-the-jennifer-strange-story/Water Pokerhttps://www.thelocal.se/20120706/41878Nintendo Game Consoleshttps://en.wikipedia.org/wiki/Nintendo_video_game_consoles2019 Narins winner, Mitchel Rosner on MDMA induced hyponatremiahttps://www.ncbi.nlm.nih.gov/pubmed/18684895And Rosner again on exercise induced hyponatremia.https://cjasn.asnjournals.org/content/2/1/151The Arieff article on the dangers of severe hyponatremia: Hyponatremia, Convulsions, Respiratory Arrest, and Permanent Brain Damage after Elective Surgery in Healthy Womenhttps://www.nejm.org/doi/full/10.1056/NEJM198606123142401The Richard Sterns article on the dangers of rapid correction of hyponatremia: Osmotic Demyelination Syndrome Following Correction of Hyponatremiahttps://www.nejm.org/doi/10.1056/NEJM198606123142402The editorial by the man himself, Robert Narins: Therapy of Hyponatremiahttps://www.nejm.org/doi/full/10.1056/NEJM198606123142409The infant study showing seizures associated with rapid correction of hypernatremia.https://www.ncbi.nlm.nih.gov/pubmed/35558?dopt=AbstractFollow up study with oral rehydration.https://www.ncbi.nlm.nih.gov/pubmed/3958850?dopt=AbstractThe Linder study of adults admitted to the ICUhttps://www.ncbi.nlm.nih.gov/pubmed/18037096French study on patients presenting to the ER with hypernatremia.https://bmcnephrol.biomedcentral.com/articles/10.1186/1471-2369-15-37Study on US veterans showing poorer outcomes with slow correction of hypernatremia.https://www.ncbi.nlm.nih.gov/pubmed/21358313Cerebral edema during the treatment of DKA.https://emj.bmj.com/content/21/2/141The MIMIC 3 Database. MIMIC is an openly available dataset developed by the MIT Lab for Computational Physiology, comprising deidentified health data associated with ~40,000 critical care patients. It includes demographics, vital signs, laboratory tests, medications, and more.https://mimic.physionet.orgChalrson Comorbidity Indexhttps://www.mdcalc.com/charlson-comorbidity-index-cci#creator-insightsThe paper: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.https://www.ncbi.nlm.nih.gov/pubmed/3558716JCI article on organic brain osmnoles in response to hypernatremiahttps://www.ncbi.nlm.nih.gov/pubmed/2332498?dopt=AbstractJohn Booth on the value of MIMIC 3https://twitter.com/ThePeanutKidney/status/1128742219471642624Sri Lekha on checking labs in hypernatremiahttps://twitter.com/LTummalapalli/status/1128479041634226176Steve Coca on chunky water administrationhttps://twitter.com/scoca1/status/1128744643422769152Steve Coca musing the Cersei’s sodium levelhttps://twitter.com/scoca1/status/1128698514026975232Steve Coca swearing in High Valarlian:https://twitter.com/scoca1/status/1128629713826721792Steve Coca proving the non-existence of hypernatremia therapy being associated with brain damage through the inability of trial lawyers to find and sue doctors for this issue:https://twitter.com/scoca1/status/1128652586612080642The original paper on the Kardashian Indexhttps://genomebiology.biomedcentral.com/articles/10.1186/s13059-014-0424-0Kardashian Index Calculatorhttp://theinformationalturn.net/kardashian-index/Facebook CEO Mark Zuckerberg says the ‘future is private’https://www.theverge.com/2019/4/30/18524188/facebook-f8-keynote-mark-zuckerberg-privacy-future-2019Khenar Jhaveri et al on ‘WhatsApp’ening in nephrology traininghttps://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfz045/5482109Mike Morrison’s video on how to rebuild the scientific posterhttps://www.youtube.com/watch?v=1RwJbhkCA58Mike’s Twitter: https://twitter.com/mikemorrison?lang=en with lot’s of examples of his design in the wild.Make your own QR code: https://www.qr-code-generator.comGoodRx: https://www.goodrx.comTen Worst Drugs for your Kidney: https://www.goodrx.com/blog/10-worst-medications-for-your-kidneys/Drugs that can falsely elevate your creatinine levels: https://www.goodrx.com/blog/drugs-cause-false-high-creatinine-levels-blood-test/Dr Orrange, not wishing to engage on Twitter in a meaningful way: https://twitter.com/Orrangemd/status/1129165083194511361

In this episode we will cover all the highlights you need to know about hypernatremia. Serum sodium... we see you yawning already! But if you want to level up your critical care skills, you need to pay attention to this often missed cause of serious morbidity in our ICUs.

Author: Katie Sprinkle, MD Educational Pearls: Hyponatremia results when patients over hydrate and dilute their sodium with too much free water Symptoms of hyponatremia can mimic symptoms of dehydration (dizziness,  lightheadedness, general malaise) With severe hyponatremia patients can progress to seizure, coma, and death Hypernatremia results from dehydration and is more common References: Bennett BL, Hew-Butler T, Hoffman MD, Rogers IR, Rosner MH; Wilderness Medical Society.. Wilderness Medical Society practice guidelines for treatment of exercise-associated hyponatremia: 2014 update. Wilderness Environ Med. 2014 Dec;25(4 Suppl):S30-42. doi: 10.1016/j.wem.2014.08.009. PubMed PMID: 25498260. Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia. Am Fam Physician. 2015 Mar 1;91(5):299-307. PubMed PMID: 25822386. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

This week's Like a Bigfoot Podcast features stories from some of my fellow racers from the Desert RATS stage race. These folks are absolutely amazing athletes and incredible human beings with stories that are intense, motivating, and will hopefully inspire you to step up to your own challenges. It was great to reconnect because, after our experience traversing the desert, we bonded into a tight knit, super positive community. This was the most surprising aspect of the race- Random strangers relying on each other and rooting for each other's success. After recapping, the power of this was something all of us felt. It is something every single person needs to experience. Desert RATS taught me why we should ALWAYS give other people the absolute best of ourselves, because WHY NOT?? In this episode we reconnect with the awesome Phil Pinti as he shares his thoughts on the race and his experiences pushing through one of the hardest race days he's ever faced. We also chat with Micky Sederburg about Hypernatremia and what happens when the wheels fall off in the middle of the most remote part of the desert. Micky's story is intense and his resolve for next year's comeback will inspire me forever. Next is Rachel Ridgway who traveled out from Maryland and talks about how she overcame a rough start to the week to finish strong. She has inspired me to always push forward no matter the obstacles. Thomas Mullins had an amazing week and taught me so much about ultrarunning, pacing, nutrition, how to properly put on sunscreen and why to buy a $20 cowboy hat. I was so grateful to finish this race with him as I could not think of a better way to run down into Moab then chasing a cowboy through the desert. Last on the podcast is Paul Scheuring. Paul summarizes the experience of Desert RATS beautifully- a group of people who, at times, are willing to bear the burden for others to succeed. It's a wonderful lesson and Paul shares a remarkable story of a fellow racer, Scott (who rocks), supporting him in the brutal most desolate moment of his race. I hope you guys enjoy! After this episode we are going to take a break from Desert RATS for a little bit. But there will be another podcast like this in a month or so with some of the other racers and crew members, because I want to give each and every person involved a chance to share their experience. See you guys next week!! MORE FROM DESERT RATS: Gemini Adventures: http://www.geminiadventures.com Desert RATS registration: https://ultrasignup.com/register.aspx?did=51488 Previous race reports: https://ultrarunning.com/featured/desert-rats-kokopelli-150-stage-race-2016/ MORE LIKE A BIGFOOT: Subscribe and Review on iTunes: https://itunes.apple.com/us/podcast/like-a-bigfoot/id1160773293?mt=2 Soundcloud Archives: https://soundcloud.com/chris-ward-126531464 Facebook Group: https://www.facebook.com/likeabigfoot/ Instagram: https://www.instagram.com/likeabigfoot/

Join John Bielinski for live CME in 2019.  www.Emergency-Medicine-Institute.com Demystifying Emergency Medicine Conference April 1-4, 2019 Marriott Key West Beachside Master labs/CXR and EKGs Urgent Care Medicine Conference July 8-11, 2019 The Lakefront Anchorage  All aspects of urgent care medicine Critical Access Emergency Medicine Conference Oct 8-11, 2019 Yellowstone For critical access providers who are solo providers

WEML#8 Show Notes Wilderness & Environmental Medicine journal online: www.wemjournal.org Questions/comments/feedback and/or interest in participating in WEM Live? Send an email to: wemlive@wms.org Part 1: Drug Doping Host Darryl Macias discusses the UIAA MedCom Consensus Guide on drug use and misuse in the mountains. Article DOI: https://doi.org/10.1089/ham.2016.0080 Part 2: Article Review Title: Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons Authors: Brian J. Krabak, Grant S. Lipman, Brandee L. Waite, Sean D. Rundell Presenters: Aaron Reilly, Trevor Mayschak Article DOI: http://dx.doi.org/10.1016/j.wem.2017.05.008 CME Available: wms.org/members Part 3: Helicopter SAR Training Host Darryl Macias provides a taste of what is involved with helicopter search and rescue training. Postproduction audio editing of the WEM Live! podcast is provided by Tom Conklin Voiceover. www.tomconklinvoice.com.

Hypernatremia -- not sexy, but we gotta get 'im done

Hypernatremia Nursing Mnemonic   You are FRIED from learning about sodium   Flushed skin Restlessness:  irritability Increased fluid retention and increased BP Edema:  peripheral and pitting Decreased urinary output, dry mouth   SWINE   (bacon has high amounts of sodium)… The post Ep4: Hypernatremia (FRIED, SWINE, SALT, MODEL) appeared first on NURSING.com.

This tiny episode covers Hypernatremia - a supplement to our Episode 8 on acid-base and hyponatremia. As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Key Texts: Tintinalli (7e) Chapters 19,21 ; Rosen's (8e) Chapters 124, 125 Thanks y'all!   -Jeremy Faust and Lauren Westafer

Evaluation and treatment of elevated serum sodium is presented.