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Abstract: PO1154

Point-of-Care Ultrasound-Assisted Management of Hyponatremia

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Chatterjee, Totini S., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Koratala, Abhilash, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Introduction

Point of care ultrasound (POCUS) is emerging as a valuable adjunct to conventional physical examination in patients with complex fluid and electrolyte disorders. Herein, we present a case of hyponatremia where nephrologist-performed focused cardiac ultrasound (FoCUS) aided in accurate diagnosis.

Case Description

A 73-year-old woman was admitted for the treatment of fractures after sustaining a fall. Nephrology was consulted for decrease in serum sodium level (to 123 mmol/L; baseline 130s). Laboratory data was significant for a urine sodium level of 46 mmol/L, urine osmolality 257 mOsm/kg, serum creatinine 0.5 mg/dL and BUN 9 mg/dL. As the patient had exertional dyspnea and crackles at lung bases, IV diuretic was administered by the rounding physician prior to urine studies. No active pain or thiazide use. X-ray showed a huge hiatal hernia with bowel contents in the chest, which was possibly mimicking crackles on auscultation and causing dyspnea. Systolic BP was in 140s. Urine sodium, though suggestive of euvolemic state, was confounded by diuretic. We performed a FoCUS exam. Left ventricular outflow tract velocity time integral (LVOT-VTI), which is a surrogate for stroke volume was lower than expected (~13 cm [normal 18-22]) suggestive of hypovolemia. Flow changes precede drop in BP. We recommended to administer normal saline and the serum sodium improved to 130 mmol/L in 2 days; VTI normalized to ~22 cm [Fig. 1]. Fig.2 illustrates stroke volume estimation using LVOT diameter and VTI. As the diameter is constant for a given person, VTI alone can be used to monitor response to therapy.

Discussion

POCUS is a valuable bedside diagnostic tool in day-to-day nephrology practice.