Hyponatremia differential diagnosis

Hyponatremia Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saeedeh Kowsarnia M.D.[2] Iqra Qamar M.D.[3]

Overview

Hyponatremia must be differentiated from other diseases that cause

Differentiating Hyponatremia from other Diseases

Disease	Clinical manifestations													Paraclinical Findings								Comments
	Symptoms and Signs													Lab Findings							Imaging
	Muscle weakness/ Cramps	Thirst	Vomiting/ Diarrhea	Confusion/ Dizziness	Seizures	Volume status	JVP	Edema	Crackles	Ascites	Tachycardia	Hypotension	Oliguria	CBC	Urine Analysis			Serum Osmolality	ADH levels	Other
															Urine Na	Urine Osm	FeNa
Renal failure						Hypervolemic									>20	-	>1%		Normal or ↑
Congestive heart failure						Hypervolemic									<10	-	<1%		↑
Cirrhosis						Hypervolemic									<10	-	<1%		↑
SIADH						Euvolemic									-	>100	-		↑
Hypothyroidism						Euvolemic									-	>100	-		↑
Adrenal insufficiency						Euvolemic									-	>100	-		↑
Psychogenic polydipsia						Euvolemic									-	<100	-		↑
Beer drinker's potomania						Euvolemic									-	<100	-		↓
Pregnancy						Euvolemic									-	Variable	-		↓
Anorexia (Chronic malnutrition)						Euvolemic									-	Variable	-		-
Diuretic induced hyponatremia						Hypovolemic									>20	-	>1%		-
Non oliguric ATN						Hypovolemic									>20	-	>1%		-
Diseases causing 3rd spacing (Pancreatitis, SBO)						Hypovolemic									<10	-	<1%		-
Gastroenteritis						Hypovolemic									<10	-	<1%		-
Sweating						Hypovolemic									<10	-	<1%		-
Pseudohyponatremia																		Normal or ↑