Hyponatremia resident survival guide: Difference between revisions
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{{familytree | G01 | | G02 | | G03 | | G04 | | | | | | | | G01= GI, Renal losses, <br> Dehydration, Diuretics, <br> Adrenal insufficiency, <br> cerebral salt wasting 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 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= Treat | {{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 etiology | H03= SIADH, Hypothyroidism | 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}} | ||
Revision as of 17:44, 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 | |||||||||||||||||||||||||||||||||||||||||||||
| 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 | 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 | 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 | ||||||||||||||||||||||||||||||||||||||||||||