Hyponatremia resident survival guide: Difference between revisions

Revision as of 17:25, 20 November 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Conditions that may cause death or permanent disability within the next 24 hours

Serum sodium < 135

Plasma osmolality

Hypotonic < 280

Isotonic/Hypertonic (Pseudohyponatremia) > 280

Assess volume status

Osmotically active compounds,
glucose, protein, lipid,
hypertonic fluid i.e. mannitol, sorbitol

Hypovolemia

Hypervolemia

Euvolemia

Treat the cause

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

GI, Renal losses,
Dehydration, Diuretics,
Adrenal insufficiency,
cerebral salt wasting syndrome

Heart failure
Cirrhosis
Renal failure

(a) Normal saline;
(b) If neurological
sign/symptoms 3%
hypertonic saline,
and furosemide

Treat the etiology

@@ Line 25: / Line 25: @@
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 {{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= | H03= | H04= }}
+{{familytree | H01 | | H02 | | H03 | | H04 | | | | | | | | H01= (a) Normal saline; <br> (b) If neurological <br> sign/symptoms 3% <br> hypertonic saline, <br> and furosemide| H02= Treat the etiology | H03= | H04= }}
 {{familytree | | | | | | | | | |!| | | |!| | | | | | | | | }}
 {{familytree | | | | | | | | | I01 | | I02 | | | | | | | | I01= | I02= }}