Hyponatremia Algorithm
 

Hyponatremia Page

·        3% Sodium Chloride injection may be used and is currently recommended for the following conditions

• severe symptomatic euvolemic hypotonic hyponatremia when serum sodium is less than 125 mEq/l
• severe symptomatic hypervolemic hypotonic hyponatremia with loop diuretics when serum sodium is less than 125 mEq/l
• severe symptomatic hypovolemic hypotonic hyponatremia  when serum sodium is less than 125 mEq/l

*severe symptomatic hypotonic hyponatremia: confusion, ataxia, seizures, obtundation, coma, respiratory arrest

Sitagliptin

·        Sitagliptin (Januvia®) P&T review: is recommended for formulary inclusion. It is FDA approved for patients 18 years of age and older for the following:

o       Monotherapy: Adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus

o       Combination Therapy: In patients with type 2 diabetes mellitus to improve glycemic control in combination with metformin or a thiazolidinedione when the single agent alone, with diet and exercise, does not provide adequate glycemic control

§        Advantages include:

·        limited or no weight gain/loss

·        low rates of hypoglycemia when compared to placebo

·        few drug interactions

·        possible regeneration of pancreatic beta cells

·        once daily oral dose

·        few gastrointestinal side effects as opposed to the GLP-1 analogues, and few adverse side effects (sore throat, upper respiratory infection, and headache)

§        Disadvantages include:

·        modest decreases in A1C when compared to other anti-diabetic agents

·        dosage adjustments for renal impairment

·        high cost

·        lack of long term safety data on immune modulating effects

o       DDP-4 is widely distributed in numerous tissues and T-cells, B-cells, and natural killer cells.

§        Long term effects on immune system are unknown. DPP-4 inhibitors have been shown to inhibit T-cell activity in vitro at high concentration; but unlikely to achieve these levels in-vivo.  DPP-4 cleaves hormones, neuropeptides, and chemokines. DPP-4 inhibitors prolong the action of hormone YY, neuropeptides (substance P), and macrophage-derived chemokines. Potential adverse effects include increased BP, inflammation, and allergic reactions.

·        Pharmacy monitoring

o       Dosing adjustment for renal dysfunction.

o       Doses greater than 100 mg per day are not recommended as additional improvement in blood glucose is not provided. Pharmacokinetics are not effected by BMI.

Protocol below approved by P&T/MEC approved 2001 at MRMC, SMH, & RCH

·        IV phosphate repletion should be limited to treatment of moderate to severe hypophosphatemia.

·        Mild to moderate serum phosphate levels may be treated with oral products.

·        When serum phosphate is > 1.5-2 mg/dl IV treatment may be switched to the oral route.

·        If serum potassium is > 3.5 meq/L sodium phosphate is recommended for IV treatment.

·        The use of lean body weight is recommended when calculating the dose.

·        Monitor serum phosphorus, calcium, magnesium, and potassium every six hours, along with blood pressure

BSR Suggested Antibiotics for Prevention of Wound Infection and Sepsis In Surgical Patients: Excel Version with infusion rate and repeat intraoperative doses