Hyponatremia resident survival guide: Difference between revisions
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{{familytree | | | | | | | | | | | A01 | | | | | | | | | | A01= '''Serum sodium < 135 mEq/L'''}} | {{familytree | | | | | | | | | | | A01 | | | | | | | | | | A01= '''Serum sodium < 135 mEq/L'''}} | ||
{{familytree | | | | | | | | | | | |!| | | | | | | | | | | }} | {{familytree | | | | | | | | | | | |!| | | | | | | | | | | }} | ||
{{familytree | | | | | | | | | | | B01 | | | | | | | | | | B01= '''Plasma | {{familytree | | | | | | | | | | | B01 | | | | | | | | | | B01= '''Plasma osmolality'''}} | ||
{{familytree | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| }} | {{familytree | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| }} | ||
{{familytree | | C01 | | | | | | | | | | | | | | | | | C02 | C01= Hypotonic < 280 | C02= Isotonic/Hypertonic <br> (Pseudohyponatremia) > 280}} | {{familytree | | C01 | | | | | | | | | | | | | | | | | C02 | C01= Hypotonic < 280 | C02= Isotonic/Hypertonic <br> (Pseudohyponatremia) > 280}} | ||
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{{familytree | F01 | | F02 | | | | F03 | | | | | | | | | | F01= Spot urine Na < 10, <br> BUN/Creatinine > 20:1, <br> Urine osmolality > 450 | F02= Same as hypovolemia, <br> Spot urine Na < 10, <br> BUN/Creatinine > 20:1, <br> Urine osmolality > 450| F03= Spot urine Na > 20, <br> BUN/Creatinine < 20:1, <br> Urine osmolality > 300 }} | {{familytree | F01 | | F02 | | | | F03 | | | | | | | | | | F01= Spot urine Na < 10, <br> BUN/Creatinine > 20:1, <br> Urine osmolality > 450 | F02= Same as hypovolemia, <br> Spot urine Na < 10, <br> BUN/Creatinine > 20:1, <br> Urine osmolality > 450| F03= Spot urine Na > 20, <br> BUN/Creatinine < 20:1, <br> Urine osmolality > 300 }} | ||
{{familytree | |!| | | |!| | | |,|-|^|-|.| | | | | | | | | }} | {{familytree | |!| | | |!| | | |,|-|^|-|.| | | | | | | | | }} | ||
{{familytree | G01 | | G02 | | G03 | | G04 | | | | | | | | G01= GI, renal losses, <br> [[dehydration]], [[diuretics]], <br> [[adrenal insufficiency]], <br> [[cerebral salt wasting]] <br> syndrome | G02= [[heart failure]] <br> [[cirrhosis]] <br> renal failure | G03= Urine osmolality > 300 | G04= Urine osmolality 50-100}} | {{familytree | G01 | | G02 | | G03 | | G04 | | | | | | | | G01= GI, renal losses, <br> [[dehydration]], [[diuretics]], <br> [[adrenal insufficiency]], <br> [[cerebral salt wasting]] <br> syndrome | G02= [[heart failure]] <br> [[cirrhosis]] <br> [[renal failure]] | G03= Urine osmolality > 300 | G04= Urine osmolality 50-100}} | ||
{{familytree | |!| | | |!| | | |!| | | |!| | | | | | | | | }} | {{familytree | |!| | | |!| | | |!| | | |!| | | | | | | | | }} | ||
{{familytree | H01 | | H02 | | H03 | | H04 | | | | | | | | H01= (a) Normal saline; <br> (b) If neurological <br> sign/symptoms 3% <br> hypertonic saline, <br> and furosemide| H02= Fluid restriction, <br> Diuretics, <br> Treat etiology | H03= [[SIADH]], [[Hypothyroidi]]sm | H04= Compulsive water drinking }} | {{familytree | H01 | | H02 | | H03 | | H04 | | | | | | | | H01= (a) Normal saline; <br> (b) If neurological <br> sign/symptoms 3% <br> hypertonic saline, <br> and [[furosemide]]| H02= Fluid restriction, <br> [[Diuretics]], <br> Treat etiology | H03= [[SIADH]], [[Hypothyroidi]]sm | H04= Compulsive water drinking }} | ||
{{familytree | | | | | | | | | |!| | | |!| | | | | | | | | }} | {{familytree | | | | | | | | | |!| | | |!| | | | | | | | | }} | ||
{{familytree | | | | | | | | | I01 | | I02 | | | | | | | | I01= (a) Fluid restriction <br> (b) Demeclocycline (if <br> fluid restriction fails) <br> (c) Vaptans; [[Conivaptan]], <br> [[Tolvaptan]] for resistant cases | I02= Treat etiology}} | {{familytree | | | | | | | | | I01 | | I02 | | | | | | | | I01= (a) Fluid restriction <br> (b) [[Demeclocycline]] (if <br> fluid restriction fails) <br> (c) Vaptans; [[Conivaptan]], <br> [[Tolvaptan]] for resistant cases | I02= Treat etiology}} | ||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 20:27, 20 November 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Definition
Causes
Life Threatening Causes
Conditions that may cause death or permanent disability within the next 24 hours
Common Causes
Management
| Serum sodium < 135 mEq/L | |||||||||||||||||||||||||||||||||||||||||||||
| Plasma osmolality | |||||||||||||||||||||||||||||||||||||||||||||
| Hypotonic < 280 | Isotonic/Hypertonic (Pseudohyponatremia) > 280 | ||||||||||||||||||||||||||||||||||||||||||||
| Assess volume status | Increase in osmotically active compounds; glucose, protein, lipid, mannitol, sorbitol | ||||||||||||||||||||||||||||||||||||||||||||
| Hypovolemia | Hypervolemia | Euvolemia | Treat etiology | ||||||||||||||||||||||||||||||||||||||||||
| Spot urine Na < 10, BUN/Creatinine > 20:1, Urine osmolality > 450 | Same as hypovolemia, Spot urine Na < 10, BUN/Creatinine > 20:1, Urine osmolality > 450 | Spot urine Na > 20, BUN/Creatinine < 20:1, Urine osmolality > 300 | |||||||||||||||||||||||||||||||||||||||||||
| GI, renal losses, dehydration, diuretics, adrenal insufficiency, cerebral salt wasting syndrome | heart failure cirrhosis renal failure | Urine osmolality > 300 | Urine osmolality 50-100 | ||||||||||||||||||||||||||||||||||||||||||
| (a) Normal saline; (b) If neurological sign/symptoms 3% hypertonic saline, and furosemide | Fluid restriction, Diuretics, Treat etiology | SIADH, Hypothyroidism | Compulsive water drinking | ||||||||||||||||||||||||||||||||||||||||||
| (a) Fluid restriction (b) Demeclocycline (if fluid restriction fails) (c) Vaptans; Conivaptan, Tolvaptan for resistant cases | Treat etiology | ||||||||||||||||||||||||||||||||||||||||||||
Do's
1) Cerebral salt wasting syndrome causes hypo-osmolar hyponatremia with lab parameters similar to that seen in SIADH. It is associated with conditions like hypovolemia, hypotension, neurosurgical procedure, and subarachnoid hemorrhage (within previous 10 days). It is treated as hypoosmolar hyponatremia. 2) While deciding the rate of normal saline for hypoosmolar hyponatremia, consideration of the following factors are helpful: patient's BMI (faster rates for higher BMI), cardiac (slower rate for low ejection fraction) and renal function (slower rates for low GFRs).