Hyponatremia causes: Difference between revisions
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|Hypotonic Hyponatremia | |Hypotonic Hyponatremia | ||
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|Etiology depends upon volume status (Hypervolemic/ Euvolemic/ Hypovolemic | |Etiology depends upon volume status (Hypervolemic/ Euvolemic/ Hypovolemic | ||
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Revision as of 14:49, 27 April 2018
Hyponatremia Microchapters |
Diagnosis |
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Treatment |
Case Studies |
Hyponatremia causes On the Web |
American Roentgen Ray Society Images of Hyponatremia causes |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saeedeh Kowsarnia M.D.[2]
Overview
Disease name] may be caused by [cause1], [cause2], or [cause3].
OR
Common causes of [disease] incl ude [cause1], [cause2], and [cause3].
OR
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
OR
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click here.
Causes
Hyponatremia results from:
- Decreased renal excretion of water is the most cases of hyponatremia, secondary to persistent action of ADH.
- Blood sampling from a vein that is being infused with hypotonic medications.
- Older techniques (e.g., flame photometry) for sodium measurement, high levels of protein or triglyceride can cause false hyponatremia (Pseudohyponatremia).
- Hyperglycemia can also cause hyponatremia, osmotic water movement from cells into the blood, resulting in a relative decrease in serum sodium concentration in the absence of hypo-osmolality.
(for each 100-mg/dL increase in glucose concentration above 100 mg/dL The sodium concentration should be increased by approximately 1.6 to 2 mmol/L)
- Excess water intake is a rare cause of hyponatremia.In psychogenic polydipsia, ingesting large volumes (>15-20 L/day) of water results in hyponatremia, in spite of preserved renal function and diluting ability.
- Medications which interfere with urinary dilution (thiazide diuretics and nonsteroidal anti-inflammatory drugs [NSAIDs]).
- Clinical disorders ( congestive heart failure, nephrotic syndrome, cirrhosis) with the reduction in effective arterial blood volume, resulting in persistent ADH activity despite hypo-osmolar plasma.
- Acute or chronic renal failure results in reduced functional nephron mass, decreased glomerular filtration rate, and therefore decreased capacity for water excretion.
Causes of Hyponatremia based upon Serum Osmolality:
Classification | Serum Osmolality | Etiology |
---|---|---|
Hypertonic Hyponatremia | Hyperglycemia, Mannitol, Glycerol, Sorbitol | |
Isotonic Hyponatremia | Lab/blood draw error,Hyperparaproteinemia,Hyperlipidemia,Post TURP (bladder irrigation with osmotic solutions) | |
Hypotonic Hyponatremia | < 280 mOsm/kg | Etiology depends upon volume status (Hypervolemic/ Euvolemic/ Hypovolemic |
Common Causes
Diagnostic criteria of SIADH/SIAD |
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|
† Mmol and Meq are the same for univalent ions like sodium
- Causes based on volume status [1]
Volume status | Sodium status | Causes |
---|---|---|
Hypovolemic
Hyponatremia[2] |
|
Bicarbonaturia ( Renal tubular acidosis, Metabolic alkalosis), Osmotic diuresis
|
Hypervolemic
Hyponatremia |
|
(due to relatively higher water versus salt intake and poor excretion),Nephrotic syndrome
|
Euvolemic
Hyponatremia |
|
postoperative nausea, pain,stress,Neoplasia (common),trauma,pregnancy
(caused by a low intake of solutes with relatively high fluid intake)
|
† Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors
- Drugs [3] :
Drug Mechanisms | Drug Classification |
---|---|
Increase ADH secretion | Antidepressants:Tricyclic antidepressants ( Amitryptiline,
Protriptyline, Desipramine),Selective serotonin reuptake inhibitors, Monoamine oxidase inhibitors Antipsychotic drugs: Phenothiazines (Thioridazine, Trifluoperazine), Butyrophenones (Haloperidol) Antiepileptic drugs: Carbamazepine, Oxcarbazepine, Sodium valproate Anticancer agents: Vinca alkaloids (Vincristine, Vinblastine), Platinum compounds (Cisplatin, Carboplatin) Alkylating agents: Intravenous, Cyclophosphamide, Melphalan, Ifosfamide Miscellaneous: Methotrexate, Interferon, Levamisole, Pentostatin, Monoclonal antibodies, MDMA, Nicotine Opiates |
Increase ADH effect | Antiepileptic drugs: Carbamazepine, Lamotrigine
Antidiabetic drugs: Chlorpropamide, Tolbutamide Anticancer agents: Alkylating agents (Intravenous cyclophosphamide) NSAIDS |
Drugs affecting water and sodium homeostasis | Diuretics:Thiazides, Indapamide, Amiloride, Loop diuretics |
Reset omostat ‡ | Antidepressants: Venlafaxine
Antiepileptic drugs:Carbamazepine |
‡ Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors
Causes by Organ System
Causes in Alphabetical Order
References
- ↑ Guillaumin, Julien; DiBartola, Stephen P. (2017). "A Quick Reference on Hyponatremia". Veterinary Clinics of North America: Small Animal Practice. 47 (2): 213–217. doi:10.1016/j.cvsm.2016.10.003. ISSN 0195-5616.
- ↑ Rondon-Berrios, Helbert; Agaba, Emmanuel I.; Tzamaloukas, Antonios H. (2014). "Hyponatremia: pathophysiology, classification, manifestations and management". International Urology and Nephrology. 46 (11): 2153–2165. doi:10.1007/s11255-014-0839-2. ISSN 0301-1623.
- ↑ Liamis, George; Milionis, Haralampos; Elisaf, Moses (2008). "A Review of Drug-Induced Hyponatremia". American Journal of Kidney Diseases. 52 (1): 144–153. doi:10.1053/j.ajkd.2008.03.004. ISSN 0272-6386.