American family physician
-
American family physician · Nov 2023
Diagnosis and Management of Sodium Disorders: Hyponatremia and Hypernatremia.
Hyponatremia and hypernatremia are electrolyte disorders that can be associated with poor outcomes. Hyponatremia is considered mild when the sodium concentration is 130 to 134 mEq per L, moderate when 125 to 129 mEq per L, and severe when less than 125 mEq per L. Mild symptoms include nausea, vomiting, weakness, headache, and mild neurocognitive deficits. ⋯ Mild hypernatremia is often caused by dehydration resulting from an impaired thirst mechanism or lack of access to water; however, other causes, such as diabetes insipidus, are possible. Treatment starts with addressing the underlying etiology and correcting the fluid deficit. When sodium is severely elevated, patients are symptomatic, or intravenous fluids are required, hypotonic fluid replacement is necessary.
-
Parasites are a source of significant illness worldwide. In the United States, giardiasis, cryptosporidiosis, cyclosporiasis, and trichinellosis are nationally notifiable conditions. Pinworm, the most common intestinal parasite in children, is not a locally notifiable infection. ⋯ Microscopy or polymerase chain reaction assays are recommended to diagnose Cyclospora infections, and sulfamethoxazole/trimethoprim may be used to treat patients with persistent diarrhea. Trichinella infection is diagnosed by serum antibody testing, and severe symptoms are treated with albendazole in patients older than one year. Pinworm infections are diagnosed visually or by a tape test or paddle test; albendazole and pyrantel pamoate are both effective treatments.