MOFFITT AM report pearls 7/17: non-hodgkin’s lymphoma / hyponatremia!

Non-Hodgkins Lymphoma PEARLS (building on our daily ditty)

  • Three types of NHL:
    • Aggressive (eg Burkitts, lymphoblastic lymphoma)
      • Often p/w onc emergencies!
      • 80% with high response rate to chemo, 45% curative! Chemo toxicities common
    • Intermediate (eg DLBCL, mantle cell lymphoma)
      • More variable clinical course and can have both aggressive and indolent properties
    • Indolent (eg follicular lymphoma, marginal zone lymphoma, CLL/SLL)
      • Very slow progression but often incurable

Hyponatremia PEARLS

  • First, r/o pseudohyponatremia – which itself can be broken down into:
    • hyperosmolar (mannitol, hyperglycemia, alcohols)
    • isoosmolar (proteins, lipids)
  • For TRUE hyponatremia – break down into hypo, eu, and hypervolemic!
    • PEARL: ALWAYS think about MEDS!!
    • hypovolemic: need to waste salt and still take in free water (eg diarrhea, diuretics). Treat with fluids.
    • euvolemic: think about endocrine disease, CNS/lung pathology, drugs, diet (polydipsia). Treat with fluid restriction +/- salt tabs.
      • PEARL: for SIADH, expect urine osm >100 and urine Na >40 (kidneys not responding appropriately). Low serum uric acid (<4) can also be helpful
    • hypervolemic: heart, liver, or renal failure. Treat with diuresis.
  • Treatment PEARL: for asymptomatic hypernatremia, correct at 8-10/day to reduce risk of central pontine myelinolysis. For SYMPTOMATIC hypernatremia, ok to correct at a faster rate!
  • Evernote: https://www.evernote.com/shard/s34/sh/28d6a0e2-b379-4823-8a29-623183ddd207/d4375cdef1d18595b11d60b0e400850b
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