Wardround 23ii7

This week’s two minute talk theme was hyponatraemia. My prize for the best talk goes to DF, a well structured and informative two minutes with a good handout to boot. I would summarise the subject by saying virtually all hyponatraemia is due to ADH excess. The challenge is to identify whether the ADH excess is appropriate or inappropriate. Checking plasma osmolality will alert you to the presence of pseudohyponatraemia or the presence of hyperglycaemia. Urine osmolality is the quick check for ADH secretion - if the osmolality is below 100 in a setting of hypo-osmolar plasma then ADH is suppressed, as in psychogenic polydipsia. Urine sodium excretion will help to differentiate appropriate and inappropriate ADH if other clinical clues have not already made the penny drop.

We briefly discussed the paper Clinical craft: a lesson from Liverpool. D M Gore. Journal of Medical Ethics 27:74-75 (2001). The author comments that Any clinician is a practitioner of a craft; assessing a patient by history and examination, addressing diagnostic possibilities, counselling patient and relatives. Many clinicians have technical craft skills on top, surgeons in particular, but no clinician practises well with technical skill alone. Our basic clinical and ward-management skills tend not to be celebrated as they might; they're not particularly exciting, novel or high-tech. .... But we also need a certain amount of pride to keep up our morale. This last sentence, true of every craft, is one which we should keep in mind.

Next week's two minute talks will be the ECG. You have your assignments. I will not be there to hear the talks but will be happy to hear them the following Tuesday if you are up to it. Remember to keep the talks concise yet precise. If you give too much information, none will be remembered.

The read and think for the coming week is In a stew. Michael A Lacombe. American Journal of Medicine. 1991;91:276-278.

Interesting topics

Hemiplegia following a sneeze


MJM