Fibrin Degradation Products (FDPs)
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stuff left after a clot dissolves. Normal process for a clot to dissolve
-Low FDPs=body not dissolving clots normally
-Normal FDPs = <10 mcg/mL
-High FDPs = (subtype is D-Dimer) = rises after thrombotic event = too
many clots
,Angiomax Antidote
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NONE
Antidiuretic Hormone (ADH/AVP/Vasopressin)
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-this is a good thing; it holds onto water when needed
-it is produced in the hypothalamus, and is a normally occurring
hormone
-it moves from the hypothalamus to pituitary to await being used
-released when the body is dehydrated to hold on to water
-concentrates the urine
-i.e. caveman and runner examples
Fluid Replacement in SIADH
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-Restrict fluids to conserve fluid from further overloading. Fluid restriction
1000mL/24 hour or even NPO may be appropriate
-Possible salt tablets used orally, especially in chronic SIADH
-IV fluids are largely to replace sodium and should be hypertonic to
conserve fluid and replace sodium
-All depend on severity of fluid volume excess and hyponatremia
-Na = 125-135 = IV solution 3% saline, used judiciously = hypertonic
solutions
-Na = <125 = critical emergency / ICU / high morbidity
, IV RATES: Not too fast! Titrate with frequent rechecks of sodium levels (q 1-
2 hr and PRN). Rate depends on patient weight = overall percent of fluid
retention (no one right answer)
-Increase of sodium should be no more than 0.5 mmol/L (0.5 mEq/L)
every HOUR
Other medications in DIC
Give this one a try later!
-Coumadin/warfarin sodium - contraindicated with DIC: blood thinner and
may make bleeding worse: inhibits activated clotting factors (nonspecific)
-Xarelto/rivaroxaban-more specific in regards to clotting factors thrombin
and factor 10/X
-Pradaxa/dabigatran - thrombin inhibitor; good clot preventer. Not a first
line treatment
-Angiomax/bivalrudin- thrombin inhibitor - used with cardiac procedures
to prevent heparin induced thrombocytopenia, used with aspirin, used after
MI to prevent clots, may be used with DIC when device is in place such as
an aortic balloon pump or ventricular assist device (something artificially
inserted)
-Streptokinase/tPA - tPA already naturally occurring in DIC process; extra
tPA as medication can be given to prevent clots. SUPER CLOT BUSTER.
Side effects: bleeding
-Recombinant Human Soluble Thrombomodulin (RHSTs): new class of
anticoagulants for DIC
Expected DI Outcomes with Treatment
Give this one a try later!
, -Urine osmolality returns to normal (500-800)
-Serum osmolality returns to normal (275-295)
- Sodium Returns to Normal
-Specific Gravity Returns to Normal (1.005-1.030)
-CT/MRI negative for structural damages
-Stable post-surgical patient
-Stabilizing I&O
-Medications delivered and/or taken as ordered
-Stable patient weight (daily)
-Free from s/sx of dehydration
Signs of Hyponatremia
Give this one a try later!
-Lethargy
-Headaches
-Hostility
-Disorientation
-Change in LOC
-Seizures
-Coma
-Decreased DTR
SIADH vs DI Lab Values
Give this one a try later!
SIADH:DI
Urine Output: < 200 mL/2 hours: >250mL/2 hours
Serum Na: <135:>135
Urine Na: <25-30: Decreased
Urine Osmolality: >800: <200-300
Give this one a try later!
stuff left after a clot dissolves. Normal process for a clot to dissolve
-Low FDPs=body not dissolving clots normally
-Normal FDPs = <10 mcg/mL
-High FDPs = (subtype is D-Dimer) = rises after thrombotic event = too
many clots
,Angiomax Antidote
Give this one a try later!
NONE
Antidiuretic Hormone (ADH/AVP/Vasopressin)
Give this one a try later!
-this is a good thing; it holds onto water when needed
-it is produced in the hypothalamus, and is a normally occurring
hormone
-it moves from the hypothalamus to pituitary to await being used
-released when the body is dehydrated to hold on to water
-concentrates the urine
-i.e. caveman and runner examples
Fluid Replacement in SIADH
Give this one a try later!
-Restrict fluids to conserve fluid from further overloading. Fluid restriction
1000mL/24 hour or even NPO may be appropriate
-Possible salt tablets used orally, especially in chronic SIADH
-IV fluids are largely to replace sodium and should be hypertonic to
conserve fluid and replace sodium
-All depend on severity of fluid volume excess and hyponatremia
-Na = 125-135 = IV solution 3% saline, used judiciously = hypertonic
solutions
-Na = <125 = critical emergency / ICU / high morbidity
, IV RATES: Not too fast! Titrate with frequent rechecks of sodium levels (q 1-
2 hr and PRN). Rate depends on patient weight = overall percent of fluid
retention (no one right answer)
-Increase of sodium should be no more than 0.5 mmol/L (0.5 mEq/L)
every HOUR
Other medications in DIC
Give this one a try later!
-Coumadin/warfarin sodium - contraindicated with DIC: blood thinner and
may make bleeding worse: inhibits activated clotting factors (nonspecific)
-Xarelto/rivaroxaban-more specific in regards to clotting factors thrombin
and factor 10/X
-Pradaxa/dabigatran - thrombin inhibitor; good clot preventer. Not a first
line treatment
-Angiomax/bivalrudin- thrombin inhibitor - used with cardiac procedures
to prevent heparin induced thrombocytopenia, used with aspirin, used after
MI to prevent clots, may be used with DIC when device is in place such as
an aortic balloon pump or ventricular assist device (something artificially
inserted)
-Streptokinase/tPA - tPA already naturally occurring in DIC process; extra
tPA as medication can be given to prevent clots. SUPER CLOT BUSTER.
Side effects: bleeding
-Recombinant Human Soluble Thrombomodulin (RHSTs): new class of
anticoagulants for DIC
Expected DI Outcomes with Treatment
Give this one a try later!
, -Urine osmolality returns to normal (500-800)
-Serum osmolality returns to normal (275-295)
- Sodium Returns to Normal
-Specific Gravity Returns to Normal (1.005-1.030)
-CT/MRI negative for structural damages
-Stable post-surgical patient
-Stabilizing I&O
-Medications delivered and/or taken as ordered
-Stable patient weight (daily)
-Free from s/sx of dehydration
Signs of Hyponatremia
Give this one a try later!
-Lethargy
-Headaches
-Hostility
-Disorientation
-Change in LOC
-Seizures
-Coma
-Decreased DTR
SIADH vs DI Lab Values
Give this one a try later!
SIADH:DI
Urine Output: < 200 mL/2 hours: >250mL/2 hours
Serum Na: <135:>135
Urine Na: <25-30: Decreased
Urine Osmolality: >800: <200-300
