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3% Sodium Chloride Injection 3% Sodium Chloride Dosing Chart For Hypotonic Hyponatremia

Hyponatremia Algorithm
 

Hyponatremia Page

ˇ        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

ˇ        Sitagliptin (JanuviaŽ) 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:

ˇ        limited or no weight gain/loss

ˇ        low rates of hypoglycemia when compared to placebo

ˇ        few drug interactions

ˇ        possible regeneration of pancreatic beta cells

ˇ        once daily oral dose

ˇ        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:

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

ˇ        dosage adjustments for renal impairment

ˇ        high cost

ˇ        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.

 

ˇ        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.

 

Dosing adjustment for renal dysfunction

Creatinine Clearance (ml/min)

Greater Than 50

30-50

Less than 30 including hemodialysis or peritoneal dialysis

Daily Dose

100 mg

50 mg

25 mg

 

BSR Patient Cost Per Day

Januvia

Metformin

(Generic)

Glipizide

 (Generic)

Rosiglitazone (Avandia)

Pioglitazone

(Actos)

25-100 mg daily

$4.58

500 mg TID

$0.30

5-20 mg Daily

$0.03-$0.09

4-8 mg Daily

$2.65-$4.90

15-45 mg Daily

$3.10-$5.38

  

Sodium Phosphate Injection

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

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

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

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

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

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

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

 

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