Hyponatremia diagnostic study of choice: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Line 132: Line 132:




* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Revision as of 19:07, 1 June 2018

Hyponatremia Microchapters

Home

Patient information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hyponatremia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiogram or Ultarsound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hyponatremia diagnostic study of choice On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hyponatremia diagnostic study of choice

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hyponatremia diagnostic study of choice

CDC on Hyponatremia diagnostic study of choice

Hyponatremia diagnostic study of choice in the news

Blogs on Hyponatremia diagnostic study of choice

Directions to Hospitals Treating hyponatremia

Risk calculators and risk factors for Hyponatremia diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saeedeh Kowsarnia M.D.[2]

Overview

Study of choice

Previously, there were two methods to determine serum sodium:

  • Flame emission spectrophotometry
  • Ion-specific electrode (ISE) potentiometry

ISE potentiometry has two different subtypes: Direct (undiluted) and indirect (diluted). Direct ISE measures plasma sodium directly from a whole-blood sample and its not associated with either pseudohyponatremia or pseudonormonatremia.

FES or indirect ISE requires sample dilution before assay [1] and both are associated with pseudohyponatremia.

Sequence of Diagnostic Studies

The most diagnostic studies which can help to diagnose and differentiate between different causes of hyponatremia are: Serum osmolality, urine osmolality, urine sodium.


Biochemical evaluation for finding the etiologies of hyponatremia :

The unnamed parameter 2= is no longer supported. Please see the documentation for {{columns-list}}.
2


For differential diagnosis click here.

Diagnostic Approach to Hyponatremia [2] [3] [4]

 
 
 
 
 
 
 
Serum sodium < 135 mEq/L
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Psuedohyponatremia
• Check for hyperglycemia
• Check for hyperproteinemia
• Check for hyperlipidemia
• Check for other solutes in serum
• Check for sign of Jaundice
• Check for history of operation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Measure serum Osmolality
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Low < 280 momol/kg
 
 
 
 
 
 
 
Normal or High
> 280 momol/kg
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypotonic Hyponatremia
 
 
 
 
 
 
 
Isoosmolar or Hyperosmolar hyponatremia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Low GFR
• History of Thiazide use
 
 
 
 
 
 
 
 
• Post TURP or hysteroscopy (Glycine, Sorbitol)
• Direct sodium by direct potentiometry if normal measure total protein and lipid
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
Yes
 
• Renal failure
• Thiazide induce hyponatremia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patients with edema
(pulmonary, peripheral), ascites
 
 
 
Signs and Symptoms of hypovolemia
(↓ BP, Orthostatic hypotension)
 
 
 
 
 
 
 
Heart failure
Cirrhosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Less < 25 mEq/L
Hypovolemic Hyponatremia
• Extra renal loss
Gastrointestinal losses, Diuretics, Third space losses
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Measure urine sodium and serum osmolality
 
 
 
 
Measure urine sodium
 
 
25 to 40 mEq/L
• Infuse Isotonic saline 1 liter over 1 hour
• Remeasure urine sodium
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urine Osm < 100
 
 
 
 
 
 
 
 
 
 
Hight > 40 mEq/L
Hypovolemic Hyponatremia
• Renal loss
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
No
 
Urine osmolality measured After therapy initiated
 
Yes
 
 
 
Use of diuretics
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Recovery from one of the followings:
• Mild hypovolemia(Patients given isotonic fluids
• Hypopituitarism
(Patients given glucocorticoids))
 
 
 
Low cortisol,
Positive ACTH stimulation
Primary adrenal insufficiency
 
 
 
Urine Na > 40 mEq/L
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Head injury/surgery
Cerebral-salt wasting
 
 
 
 
 
 
 
No
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patient with rapid water consumption
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ensure that sodium intake > 150 mEq/L over next 24 hours (infuse 1 liter of isotonic fluid over one or more hour)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Remeasure urine osmolality and sodium
 
 
 
 
 
 
 
No
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
High-fluid
low-protein diet including:
• Beer potomania
• Tea and toast diet
 
Water intoxication:
• Psychosis
• Endurance activity (Marathone)
• Ecstasy use
 
 
 
 
 
Urine Na >40 or
Urine Osm > 100
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urine Na < 40 or
Urine Osm < 100
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypovolemic Hyponatremia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check for:
• Glucocorticoid deficiency with
Cortisol level and ACTH stimulationand
• Hypothyroidism with TSH
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
check morning cortisol and
ACTH stimulation test
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Glucocorticoid deficiency
 
Elevated TSH
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SIAD
Nephrogenic SIAD
Reset Osmostat
 
 
Severe Hypothyroidism
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Evaluate underlying etiology
 
 
 
 
 
 
 
 
 


References

  1. ↑ Hussain, Iram; Ahmad, Zahid; Garg, Abhimanyu (2015). "Extreme hypercholesterolemia presenting with pseudohyponatremia - a case report and review of the literature". Journal of Clinical Lipidology. 9 (2): 260–264. doi:10.1016/j.jacl.2014.11.007. ISSN 1933-2874.
  2. ↑ Adrogué, Horacio J.; Madias, Nicolaos E. (2014). "Diagnosis and Treatment of Hyponatremia". American Journal of Kidney Diseases. 64 (5): 681–684. doi:10.1053/j.ajkd.2014.06.001. ISSN 0272-6386.
  3. ↑ Sahay, Manisha; Sahay, Rakesh (2014). "Hyponatremia: A practical approach". Indian Journal of Endocrinology and Metabolism. 18 (6): 760. doi:10.4103/2230-8210.141320. ISSN 2230-8210.
  4. ↑ E. J. Hoorn, M. L. Halperin & R. Zietse (2005). "Diagnostic approach to a patient with hyponatraemia: traditional versus physiology-based options". QJM : monthly journal of the Association of Physicians. 98 (7): 529–540. doi:10.1093/qjmed/hci081. PMID 15955797. Unknown parameter |month= ignored (help)

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Hyponatremia_diagnostic_study_of_choice&oldid=1474138"