An elderly female with depression presents with fall, found to be hyponatremic to 112. This was ultimately though secondary to celexa, and improved with gentle fluids as well as holding that medication. During her work-up, an adrenal incidentaloma was discovered; we discussed the recommended management of these.
*When is hyponatremia severe enough to merit use of hypertonic saline?
-although expert panel recommendations include the use of hypertonic saline for a range of symptoms and sodium levels (see below), it is onlyabsolutely indicated for patients with acute hyponatremia w/ severe symptoms (coma, seizures, obtundation, respiratory arrest)
-see review for recommended rates of correction and what to do when someone is correcting too quickly
*Approach to adrenal incidentaloma:
-incidental benign adrenal nodes are COMMON, especially as people get older
-Dr. Kanter quoted 4cm as the size above which adrenal nodes should be surgically removed