‘Dexmedetomidine is the S-enantiomer of the veterinary sedative medetomidine. It is a highly selective α2-adrenoceptor agonist’
BJA Ed ‘Dexmedetomedine: its use in intensive care medicine and anaesthesia’
1c)
The ESE/ESICM joint guidelines on hyponatraemia 2014 classify symptoms in to ‘moderately severe’ and ‘severe’ only. Otherwise I guess they’re considered asymptomatic. For any patient with symptoms falling into these categories, hypertonic saline is recommended.
Also, if a patient had – what was traditionally considered – ‘mild’ symptoms of hyponatraemia, we should treat based on cause in any case. If the hyponatraemia and symptoms were caused by SIADH, for example, then fluid restriction would be the correcting measure of choice, not additional fluids.
3d – in the SPC for Dexmed (https://www.medicines.org.uk/emc/product/4783/smpc) it lists respiratory depression as “very common” and occurring in 38 % in dexmedetomidine-group vs. 35 % in placebo-group receiving rescue midazolam and fentanyl). Though whether this is dose related I’m unsure.
I’m pretty sure 3. a is true
‘Dexmedetomidine is the S-enantiomer of the veterinary sedative medetomidine. It is a highly selective α2-adrenoceptor agonist’
BJA Ed ‘Dexmedetomedine: its use in intensive care medicine and anaesthesia’
A is false, the question asks if it is an antagonist
Oh yes sorry misread!
1c)
The ESE/ESICM joint guidelines on hyponatraemia 2014 classify symptoms in to ‘moderately severe’ and ‘severe’ only. Otherwise I guess they’re considered asymptomatic. For any patient with symptoms falling into these categories, hypertonic saline is recommended.
Also, if a patient had – what was traditionally considered – ‘mild’ symptoms of hyponatraemia, we should treat based on cause in any case. If the hyponatraemia and symptoms were caused by SIADH, for example, then fluid restriction would be the correcting measure of choice, not additional fluids.
Agree with this. Here is the link to the Society for Endocrinology’s publication on it: https://ec.bioscientifica.com/view/journals/ec/5/5/G4.xml (Lead author is department of endocrinology at MRI).
3d – in the SPC for Dexmed (https://www.medicines.org.uk/emc/product/4783/smpc) it lists respiratory depression as “very common” and occurring in 38 % in dexmedetomidine-group vs. 35 % in placebo-group receiving rescue midazolam and fentanyl). Though whether this is dose related I’m unsure.