Hyponatremia classification: Difference between revisions
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Classification based on '''duration<ref name="SternsIngelfinger2015">{{cite journal|last1=Sterns|first1=Richard H.|last2=Ingelfinger|first2=Julie R.|title=Disorders of Plasma Sodium — Causes, Consequences, and Correction|journal=New England Journal of Medicine|volume=372|issue=1|year=2015|pages=55–65|issn=0028-4793|doi=10.1056/NEJMra1404489}}</ref> :''' | Classification based on '''duration<ref name="SternsIngelfinger2015">{{cite journal|last1=Sterns|first1=Richard H.|last2=Ingelfinger|first2=Julie R.|title=Disorders of Plasma Sodium — Causes, Consequences, and Correction|journal=New England Journal of Medicine|volume=372|issue=1|year=2015|pages=55–65|issn=0028-4793|doi=10.1056/NEJMra1404489}}</ref> :''' | ||
* '''Hyper acute <ref name="Thomas2017">{{cite journal|last1=Thomas|first1=Sarah Beth|title=Acute hypervolemic hyponatremia|journal=Nursing|volume=47|issue=10|year=2017|pages=53–57|issn=0360-4039|doi=10.1097/01.NURSE.0000522006.83149.20}}</ref>:''' Develops in a few hours, excess water intake, impaired water excretion, runners, users of the recreational drug (Ecstasy) | * '''Hyper acute <ref name="Thomas2017">{{cite journal|last1=Thomas|first1=Sarah Beth|title=Acute hypervolemic hyponatremia|journal=Nursing|volume=47|issue=10|year=2017|pages=53–57|issn=0360-4039|doi=10.1097/01.NURSE.0000522006.83149.20}}</ref>:''' Develops in a few hours, excess water intake, impaired water excretion, runners, users of the recreational drug ([[Ecstasy (drug)|Ecstasy]]) | ||
* '''Acute:''' Rapid onset <48 hours, surgeries, [[colonoscopy]] preparation, [[polydipsia]], [[Diuretic|diuretics]] | * '''Acute:''' Rapid onset <48 hours, surgeries, [[colonoscopy]] preparation, [[polydipsia]], [[Diuretic|diuretics]] | ||
* '''Chronic:''' Gradual onset >48 hours, caused by chronic disease ( including cardiac, renal, hepatic and other conditions) | * '''Chronic:''' Gradual onset >48 hours, caused by [[chronic disease]] ( including cardiac, renal, hepatic and other conditions) | ||
<small>( Etiologies cause hyperacute and acute hyponatremia are applicable to each category interchangeably depending on the onset of symptoms)</small> | <small>( Etiologies cause hyperacute and acute hyponatremia are applicable to each category interchangeably depending on the onset of symptoms)</small> | ||
Classification based on '''ADH''' level : | Classification based on '''[[ADH]]''' level : | ||
* '''↑ ADH:''' Volume depletion (GI loss, Renal loss) , decreased perfusion ( CHF, Cirrhosis), increased ADH secretion, reset osmostat | * '''↑ ADH:''' Volume depletion (GI loss, Renal loss) , decreased [[perfusion]] ( [[CHF]], [[Cirrhosis]]), increased [[ADH]] secretion, reset osmostat | ||
* '''↓ ADH:''' Primary polydipsia, ↓ dietary solute intake, advanced renal failure | * '''↓ ADH:''' Primary polydipsia, ↓ dietary solute intake, advanced [[renal failure]] | ||
Classification based upon '''osmolality''' <ref>{{Cite journal | Classification based upon '''[[osmolality]]''' <ref>{{Cite journal | ||
| author = [[A. I. Arieff]] & [[H. J. Carroll]] | | author = [[A. I. Arieff]] & [[H. J. Carroll]] | ||
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* '''Norotonic hyponatremia:''' Serum osmolality 275–295 mOsm/kg | * '''Norotonic hyponatremia:''' Serum osmolality 275–295 mOsm/kg | ||
According to '''volume status :''' | According to '''[[volume status]] :''' | ||
{| class="wikitable" | {| class="wikitable" | ||
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* total body sodium ↓↓ | * total body sodium ↓↓ | ||
| | | | ||
* '''True volume depletion:GI loss, | * '''True [[volume depletion]]: GI loss, renal loss, [[insensible loss]]''' | ||
|- | |- | ||
|'''<big>Euvolemic</big>''' | |'''<big>Euvolemic</big>''' | ||
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* total body sodium ↔ | * total body sodium ↔ | ||
| | | | ||
* '''Drugs, | * '''Drugs, increased [[ADH]] level, reset [[osmostat]], low dietary salt intake''' | ||
|- | |- | ||
|'''<big>Hypervolemic Hyponatremia</big>''' | |'''<big>Hypervolemic Hyponatremia</big>''' | ||
| Line 78: | Line 78: | ||
* total body sodium ↑ | * total body sodium ↑ | ||
| | | | ||
* '''Decrease effective arterial volume: Cirrhosis, Renal disease, CHF''' | * '''Decrease effective arterial volume: [[Cirrhosis]], [[Renal disease]], [[CHF]]''' | ||
|} | |} | ||
Revision as of 00:01, 21 May 2018
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Hyponatremia Microchapters |
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Hyponatremia classification On the Web |
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American Roentgen Ray Society Images of Hyponatremia classification |
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Risk calculators and risk factors for Hyponatremia classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saeedeh Kowsarnia M.D.[2]
Overview
hyponatremia, serum sodium less than 135 mEq/L (mmol/L),is classified based on ADH level, duration of hyponatremia, serum osmolality and volume status.
Classification
Hyponatremia is defined as serum sodium less than 135 mEq/L (mmol/L) [1] .There are different classifications for hyponatremia based on duration, severity, volume status, ADH level and serum osmolality.
Hyponatremia is classified based on serum sodium level to [2] :
- Mild : Serum sodium 130– 135 mmol/L
- Moderate: Serum sodium ≤125–129 mmol/L
- Severe: Serum sodium <124 mmol/L
Classification based on duration[3] :
- Hyper acute [4]: Develops in a few hours, excess water intake, impaired water excretion, runners, users of the recreational drug (Ecstasy)
- Acute: Rapid onset <48 hours, surgeries, colonoscopy preparation, polydipsia, diuretics
- Chronic: Gradual onset >48 hours, caused by chronic disease ( including cardiac, renal, hepatic and other conditions)
( Etiologies cause hyperacute and acute hyponatremia are applicable to each category interchangeably depending on the onset of symptoms)
Classification based on ADH level :
- ↑ ADH: Volume depletion (GI loss, Renal loss) , decreased perfusion ( CHF, Cirrhosis), increased ADH secretion, reset osmostat
- ↓ ADH: Primary polydipsia, ↓ dietary solute intake, advanced renal failure
Classification based upon osmolality [5]:
- Hypertonic hyponatremia: Serum osmolality >295 mOsm/kg
- Hypotonic hyponatremia: Serum osmolality < 275 mOsm/kg
- Norotonic hyponatremia: Serum osmolality 275–295 mOsm/kg
According to volume status :
| Volume status | Sodium status | Causes |
|---|---|---|
| Hypovolemic
Hyponatremia |
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| Euvolemic
Hyponatremia |
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| Hypervolemic Hyponatremia |
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References
- ↑ Upadhyay, Ashish; Jaber, Bertrand L.; Madias, Nicolaos E. (2006). "Incidence and Prevalence of Hyponatremia". The American Journal of Medicine. 119 (7): S30–S35. doi:10.1016/j.amjmed.2006.05.005. ISSN 0002-9343.
- ↑ Laczi, Ferenc (2008). "Etiology, diagnostics and therapy of hyponatremias". Orvosi Hetilap. 149 (29): 1347–1354. doi:10.1556/OH.2008.28409. ISSN 0030-6002.
- ↑ Sterns, Richard H.; Ingelfinger, Julie R. (2015). "Disorders of Plasma Sodium — Causes, Consequences, and Correction". New England Journal of Medicine. 372 (1): 55–65. doi:10.1056/NEJMra1404489. ISSN 0028-4793.
- ↑ Thomas, Sarah Beth (2017). "Acute hypervolemic hyponatremia". Nursing. 47 (10): 53–57. doi:10.1097/01.NURSE.0000522006.83149.20. ISSN 0360-4039.
- ↑ A. I. Arieff & H. J. Carroll (1972). "Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases". Medicine. 51 (2): 73–94. PMID 5013637. Unknown parameter
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