Just saw 2 ICU hyperNa cases, so here's a #medsky #nephsky🧵 on why...
🤨 Out: Solute-free H2O clearance
😎 In: Electrolyte-free H2O clearance
🫘 1st was recovering from AKI -->⬆️ filtered urea load as the BUN ⬇️
🥩 2nd was receiving very high protein tube feeds -->⬆️ filtered urea load with stable BUN
🤨 Out: Solute-free H2O clearance
😎 In: Electrolyte-free H2O clearance
🫘 1st was recovering from AKI -->⬆️ filtered urea load as the BUN ⬇️
🥩 2nd was receiving very high protein tube feeds -->⬆️ filtered urea load with stable BUN
November 21, 2024 at 3:09 PM
Yup.
We discussed the JASN study from @scoca1.bsky.social et al on #NephJC here www.nephjc.com/news/hyperna...
Podcast: www.nephjc.com/freelyfilter...
We discussed the JASN study from @scoca1.bsky.social et al on #NephJC here www.nephjc.com/news/hyperna...
Podcast: www.nephjc.com/freelyfilter...
Fixing Hypernatremia: Acting Fast or Acting Slow? — NephJC
They always said not to correct hypernatremia faster than 0.5 mmol/L/hour but what do they know and who are they anyways? New data questions this ancient dogma.
www.nephjc.com
April 17, 2025 at 1:43 PM
Yup.
We discussed the JASN study from @scoca1.bsky.social et al on #NephJC here www.nephjc.com/news/hyperna...
Podcast: www.nephjc.com/freelyfilter...
We discussed the JASN study from @scoca1.bsky.social et al on #NephJC here www.nephjc.com/news/hyperna...
Podcast: www.nephjc.com/freelyfilter...
📣 Serum sodium ≠ total body sodium
🤔Why does this matter?👇
https://youtu.be/H_Ueh1PfS7M
Usually..
🧂 Na⁺-> ECF volume.
💧 Water -> osmolality.
HypoNa+ & hyperNa+ make sense.
www.abckidney.com for immersive education
#NephSky #FOAMed #MedEd #Physiology #Electrolytes
🤔Why does this matter?👇
https://youtu.be/H_Ueh1PfS7M
Usually..
🧂 Na⁺-> ECF volume.
💧 Water -> osmolality.
HypoNa+ & hyperNa+ make sense.
www.abckidney.com for immersive education
#NephSky #FOAMed #MedEd #Physiology #Electrolytes
February 24, 2026 at 6:01 PM
📣 Serum sodium ≠ total body sodium
🤔Why does this matter?👇
https://youtu.be/H_Ueh1PfS7M
Usually..
🧂 Na⁺-> ECF volume.
💧 Water -> osmolality.
HypoNa+ & hyperNa+ make sense.
www.abckidney.com for immersive education
#NephSky #FOAMed #MedEd #Physiology #Electrolytes
🤔Why does this matter?👇
https://youtu.be/H_Ueh1PfS7M
Usually..
🧂 Na⁺-> ECF volume.
💧 Water -> osmolality.
HypoNa+ & hyperNa+ make sense.
www.abckidney.com for immersive education
#NephSky #FOAMed #MedEd #Physiology #Electrolytes
The doses of bicarb used were aggressive
Interquartile range for total cumulative dose was 500-1000 ml of 4.2% bicarbonate
That's equivalent to 5-10 amps (50 ml vials) of 8.4% in the USA
You can use a LOT of bicarb if you have to (titrated to effect; also look at Na levels & avoid hyperNa)
#4/4
Interquartile range for total cumulative dose was 500-1000 ml of 4.2% bicarbonate
That's equivalent to 5-10 amps (50 ml vials) of 8.4% in the USA
You can use a LOT of bicarb if you have to (titrated to effect; also look at Na levels & avoid hyperNa)
#4/4
a woman in a red dress is saying we go hard bravo
ALT: a woman in a red dress is saying we go hard bravo
media.tenor.com
October 29, 2025 at 2:59 PM
The doses of bicarb used were aggressive
Interquartile range for total cumulative dose was 500-1000 ml of 4.2% bicarbonate
That's equivalent to 5-10 amps (50 ml vials) of 8.4% in the USA
You can use a LOT of bicarb if you have to (titrated to effect; also look at Na levels & avoid hyperNa)
#4/4
Interquartile range for total cumulative dose was 500-1000 ml of 4.2% bicarbonate
That's equivalent to 5-10 amps (50 ml vials) of 8.4% in the USA
You can use a LOT of bicarb if you have to (titrated to effect; also look at Na levels & avoid hyperNa)
#4/4
📣 Serum sodium ≠ total body sodium
🤔Why does this matter?👇
https://youtu.be/H_Ueh1PfS7M
Usually..
🧂 Na⁺-> ECF volume.
💧 Water -> osmolality.
HypoNa+ & hyperNa+ make sense.
www.abckidney.com for immersive education
#NephSky #FOAMed #MedEd #Physiology #Electrolytes
🤔Why does this matter?👇
https://youtu.be/H_Ueh1PfS7M
Usually..
🧂 Na⁺-> ECF volume.
💧 Water -> osmolality.
HypoNa+ & hyperNa+ make sense.
www.abckidney.com for immersive education
#NephSky #FOAMed #MedEd #Physiology #Electrolytes
February 28, 2026 at 6:00 PM
📣 Serum sodium ≠ total body sodium
🤔Why does this matter?👇
https://youtu.be/H_Ueh1PfS7M
Usually..
🧂 Na⁺-> ECF volume.
💧 Water -> osmolality.
HypoNa+ & hyperNa+ make sense.
www.abckidney.com for immersive education
#NephSky #FOAMed #MedEd #Physiology #Electrolytes
🤔Why does this matter?👇
https://youtu.be/H_Ueh1PfS7M
Usually..
🧂 Na⁺-> ECF volume.
💧 Water -> osmolality.
HypoNa+ & hyperNa+ make sense.
www.abckidney.com for immersive education
#NephSky #FOAMed #MedEd #Physiology #Electrolytes
Agree - kids seem to be at negligible risk of CPM, so I tend to lean into quicker correction of hypoNa (bolus 3% until symptoms resolve and then aim for 10 meq/day but tolerate a bit faster). I’m more careful the other way given cerebral edema concerns, and lower risk of morbidity from hyperNa
November 19, 2024 at 4:45 PM
Agree - kids seem to be at negligible risk of CPM, so I tend to lean into quicker correction of hypoNa (bolus 3% until symptoms resolve and then aim for 10 meq/day but tolerate a bit faster). I’m more careful the other way given cerebral edema concerns, and lower risk of morbidity from hyperNa
Et n'oublions pas que la précaution concernant la correction de l'hyperNa n'est qu'une extrapolation "de bon sens" d'observations chez l'enfant (aucun report convaincant d’œdème cérébral observé chez l'adulte dans la moindre étude clinique en cas de correction rapide d'une HyperNa).
Tous les dogmes médicaux tombent un à un...et pas pour les bonnes raisons...juste parce que l'on a suivi la mauvaise recherche mandarinale ancestrale, dans laquelle les vérités étaient celles du grand professeur
How fast are you correcting hyponatremia? Scared of demyelination? Did you know that slower rate are associated with more death?? #FOAMed
December 9, 2024 at 1:33 PM
Et n'oublions pas que la précaution concernant la correction de l'hyperNa n'est qu'une extrapolation "de bon sens" d'observations chez l'enfant (aucun report convaincant d’œdème cérébral observé chez l'adulte dans la moindre étude clinique en cas de correction rapide d'une HyperNa).
Interesting, APROCCHHS did have a benefit, but I hear you with the discordant ADRENAL/CORTICUS; hyperNa-ICU outcomes are unlikely to be causal unless [Na] >160 (which even Conns/Connshings doesn't do--usually 145-150... much less fludrocortisone @bhallaresearch.bsky.social )
November 22, 2024 at 7:58 PM
Interesting, APROCCHHS did have a benefit, but I hear you with the discordant ADRENAL/CORTICUS; hyperNa-ICU outcomes are unlikely to be causal unless [Na] >160 (which even Conns/Connshings doesn't do--usually 145-150... much less fludrocortisone @bhallaresearch.bsky.social )
The only thing I can think of that even comes close is Hypernauts, this weird forgotten TV show with terrible CG that was all about these young adults solving problems in a space academy with giant robots en.m.wikipedia.org/wiki/Hyperna...
March 6, 2025 at 5:48 AM
The only thing I can think of that even comes close is Hypernauts, this weird forgotten TV show with terrible CG that was all about these young adults solving problems in a space academy with giant robots en.m.wikipedia.org/wiki/Hyperna...
-isotonic HCO3 (put HCO3 in 1L D5W) for volume resuscitation in AGMA (excess volume overload)
-hypertonic HCO3 (undiluted amps) for hypoNa & cerebral edema (hypertonic draws fluid out) (excess HyperNa, pCO2↑)
- pamidronate/zoledronic acid in D5W in hyperCa/acidosis (NS can further acidify pH&↑iCa)
-hypertonic HCO3 (undiluted amps) for hypoNa & cerebral edema (hypertonic draws fluid out) (excess HyperNa, pCO2↑)
- pamidronate/zoledronic acid in D5W in hyperCa/acidosis (NS can further acidify pH&↑iCa)
December 10, 2024 at 9:10 PM
-isotonic HCO3 (put HCO3 in 1L D5W) for volume resuscitation in AGMA (excess volume overload)
-hypertonic HCO3 (undiluted amps) for hypoNa & cerebral edema (hypertonic draws fluid out) (excess HyperNa, pCO2↑)
- pamidronate/zoledronic acid in D5W in hyperCa/acidosis (NS can further acidify pH&↑iCa)
-hypertonic HCO3 (undiluted amps) for hypoNa & cerebral edema (hypertonic draws fluid out) (excess HyperNa, pCO2↑)
- pamidronate/zoledronic acid in D5W in hyperCa/acidosis (NS can further acidify pH&↑iCa)
One thing that stood out for me @scoca1 is that you found 30% of hospital acquired hyperNa corrected faster than 5 mEq/L/hr. My experience is that if we get to convince the ICU team To give a bit of H2O and reduce sNa by 2 per day it’s a colossal success #NephJC
December 17, 2024 at 7:49 PM
One thing that stood out for me @scoca1 is that you found 30% of hospital acquired hyperNa corrected faster than 5 mEq/L/hr. My experience is that if we get to convince the ICU team To give a bit of H2O and reduce sNa by 2 per day it’s a colossal success #NephJC
7/x at that point, a way 2 find out: measure lytes in GI fluid: Na <100 (it explains hyperNa), CO2 <5!, Cl 116! So there you go. Massive chloride loss led to this whooping degree of metabolic alkalosis. Background of AKI-RRT negated a way to exchange Cl 4 HCO3 by IC-B cells w/NS
December 16, 2024 at 12:38 PM
7/x at that point, a way 2 find out: measure lytes in GI fluid: Na <100 (it explains hyperNa), CO2 <5!, Cl 116! So there you go. Massive chloride loss led to this whooping degree of metabolic alkalosis. Background of AKI-RRT negated a way to exchange Cl 4 HCO3 by IC-B cells w/NS
3/3 add that to a pt in the ICU who was on a ventilator or sedated without access to water. The perfect storm occurs if high protein tube feeds are added or if azotemia was pronounced. All adds up and hyperNa ensues.
November 22, 2024 at 5:11 AM
3/3 add that to a pt in the ICU who was on a ventilator or sedated without access to water. The perfect storm occurs if high protein tube feeds are added or if azotemia was pronounced. All adds up and hyperNa ensues.
1/3 think it’s important to add to the equation: 1) impairment in urine concentration and 2) ⬇️access to 💧. This type of hyperNa post-resolving AKI does not apply to all causes of AKI. For instance, it’s not common in pts who recover from prerenal azotemia, acute GN or average ATN on the floor
November 22, 2024 at 5:11 AM
1/3 think it’s important to add to the equation: 1) impairment in urine concentration and 2) ⬇️access to 💧. This type of hyperNa post-resolving AKI does not apply to all causes of AKI. For instance, it’s not common in pts who recover from prerenal azotemia, acute GN or average ATN on the floor
BICAR-ICU
389 adults with severe acidemia randomized to 4.2% IV bicarb vs usual care. Overall primary outcome neutral, but in AKI stage 2–3 bicarb ↓ composite events, mortality, organ failure & KRT use (52%→35%). More alkalosis, hyperNa, hypoCa. #KidneyWk
389 adults with severe acidemia randomized to 4.2% IV bicarb vs usual care. Overall primary outcome neutral, but in AKI stage 2–3 bicarb ↓ composite events, mortality, organ failure & KRT use (52%→35%). More alkalosis, hyperNa, hypoCa. #KidneyWk
November 8, 2025 at 3:37 PM
BICAR-ICU
389 adults with severe acidemia randomized to 4.2% IV bicarb vs usual care. Overall primary outcome neutral, but in AKI stage 2–3 bicarb ↓ composite events, mortality, organ failure & KRT use (52%→35%). More alkalosis, hyperNa, hypoCa. #KidneyWk
389 adults with severe acidemia randomized to 4.2% IV bicarb vs usual care. Overall primary outcome neutral, but in AKI stage 2–3 bicarb ↓ composite events, mortality, organ failure & KRT use (52%→35%). More alkalosis, hyperNa, hypoCa. #KidneyWk
Just admitted a pt w
hyperosmolar hyperglycemic nonket syndrome (Glu 950), AKI and hyperNa (162). New onset diabetes. Triggering factor? He was diagnosed with COVID-19 5 ds ago and was placed on steroids/azithro. He is on room air.
Being COVID(+) is NOT indication for steroids!
hyperosmolar hyperglycemic nonket syndrome (Glu 950), AKI and hyperNa (162). New onset diabetes. Triggering factor? He was diagnosed with COVID-19 5 ds ago and was placed on steroids/azithro. He is on room air.
Being COVID(+) is NOT indication for steroids!
December 4, 2024 at 11:49 AM
Just admitted a pt w
hyperosmolar hyperglycemic nonket syndrome (Glu 950), AKI and hyperNa (162). New onset diabetes. Triggering factor? He was diagnosed with COVID-19 5 ds ago and was placed on steroids/azithro. He is on room air.
Being COVID(+) is NOT indication for steroids!
hyperosmolar hyperglycemic nonket syndrome (Glu 950), AKI and hyperNa (162). New onset diabetes. Triggering factor? He was diagnosed with COVID-19 5 ds ago and was placed on steroids/azithro. He is on room air.
Being COVID(+) is NOT indication for steroids!
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By: tarjavirmakari on Wednesday, April 8, 2026
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SERPENTHEIR Release New Video ‘The Lamplights’ from Upcoming “Iridescence” Album
SERPENTHEIR is a Gdańsk-based experimental metal project rooted in symphonic black and melodic death metal. With a versatile discography of 4.5 albums, including the phantasmagorical ‘Hyperna…
metalshockfinland.com
April 9, 2026 at 5:35 AM
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By: Vic on Saturday, February 21, 2026
By: Vic on Saturday, February 21, 2026
SERPENTHEIR new music video Celebrations is out now!
Serpentheir is a Gdańsk-based experimental metal project rooted in symphonic black and melodic death metal. With a versatile discography of 4.5 albums, including the phantasmagorical ‘Hyperna…
www.dropthespotlight.com
February 22, 2026 at 5:48 AM
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By: Vic on Saturday, February 21, 2026
By: Vic on Saturday, February 21, 2026
Why does a patient need to be given any "input"?
- Fluids: for volume if hypovolemic most commonly. (always think what's the indicn; eg, hyperK, hyperCa, hyperNa, rhabdo, ==> give the appropriate fluids).
- Nutrition
Oral preferred (or NGT/PEG). If not, IV.
However:
- Fluids: for volume if hypovolemic most commonly. (always think what's the indicn; eg, hyperK, hyperCa, hyperNa, rhabdo, ==> give the appropriate fluids).
- Nutrition
Oral preferred (or NGT/PEG). If not, IV.
However:
May 22, 2025 at 2:19 PM
Why does a patient need to be given any "input"?
- Fluids: for volume if hypovolemic most commonly. (always think what's the indicn; eg, hyperK, hyperCa, hyperNa, rhabdo, ==> give the appropriate fluids).
- Nutrition
Oral preferred (or NGT/PEG). If not, IV.
However:
- Fluids: for volume if hypovolemic most commonly. (always think what's the indicn; eg, hyperK, hyperCa, hyperNa, rhabdo, ==> give the appropriate fluids).
- Nutrition
Oral preferred (or NGT/PEG). If not, IV.
However:
＞たった2オングストロームのデバイスを製造できるとは誰も想像できないだろう。微細化はある時点で必ず止まる
HyperNAなら2Aに近いとこまではいけるってことかな。
HyperNAなら2Aに近いとこまではいけるってことかな。
開口数0.75の「Hyper-NA」EUV装置 2030年に登場か
ASMLはimecの年次イベントで、次世代のEUV（極端紫外線）リソグラフィ装置のロードマップについて言及した。開口数（NA）が0.75の「Hyper-NA」リソグラフィ装置を開発中だという。
eetimes.itmedia.co.jp
June 18, 2024 at 3:38 AM
＞たった2オングストロームのデバイスを製造できるとは誰も想像できないだろう。微細化はある時点で必ず止まる
HyperNAなら2Aに近いとこまではいけるってことかな。
HyperNAなら2Aに近いとこまではいけるってことかな。
Na sieving when dextrose dialysate is used
Early in dwell there is a higher fraction of peritoneal aquaporins contributing to UF
This means more Na free H20 removal contributing to Net UF
So short fast dwells lead to hyperNa, thirst + viscous cycle of high fluid intake
Early in dwell there is a higher fraction of peritoneal aquaporins contributing to UF
This means more Na free H20 removal contributing to Net UF
So short fast dwells lead to hyperNa, thirst + viscous cycle of high fluid intake
November 16, 2024 at 11:28 PM
Na sieving when dextrose dialysate is used
Early in dwell there is a higher fraction of peritoneal aquaporins contributing to UF
This means more Na free H20 removal contributing to Net UF
So short fast dwells lead to hyperNa, thirst + viscous cycle of high fluid intake
Early in dwell there is a higher fraction of peritoneal aquaporins contributing to UF
This means more Na free H20 removal contributing to Net UF
So short fast dwells lead to hyperNa, thirst + viscous cycle of high fluid intake
ASML CEO Christophe Fouquet, who took the helm in 2024, is focused on transitioning from extreme ultraviolet (EUV) lithography to high numerical aperture (High NA) EUV technology.
#ASML #ASMLStock #ASMLNews #Semiconductors #HighNA #HyperNA #EUV
$ASML
#ASML #ASMLStock #ASMLNews #Semiconductors #HighNA #HyperNA #EUV
$ASML
December 15, 2025 at 4:34 PM
ASML CEO Christophe Fouquet, who took the helm in 2024, is focused on transitioning from extreme ultraviolet (EUV) lithography to high numerical aperture (High NA) EUV technology.
#ASML #ASMLStock #ASMLNews #Semiconductors #HighNA #HyperNA #EUV
$ASML
#ASML #ASMLStock #ASMLNews #Semiconductors #HighNA #HyperNA #EUV
$ASML