Hyponatremia physical examination
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Risk calculators and risk factors for Hyponatremia physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saeedeh Kowsarnia M.D.[2]
Overview
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
Physical Examination
- Nausea and malaise are the earliest signs of hyponatremia.
| Classification | Clinical signs |
|---|---|
| Hypervolemic
hyponatremia |
Peripheral edema, ascites, pulmonary edema, raised JVP,clinical signs of underlying causes |
| Euvolemic hyponatremia | Clinical signs of underlying causes |
| Hypovolemic hyponatremia | Dry mucous membrane, decreased skin turgor, hypotension (orthostatic), tachycardia |
- Look for signs of hypothyroidism
- Look for signs of adrenal insufficiency
- Detailed examination to detect any CNS or lung lesion
Appearance of the Patient
- Patients with hyponatremia may appear with wide range of presentations from no discomfort to severe distress
Vital Signs
- High-grade / low-grade fever
- Hypothermia / hyperthermia may be present
- Tachycardia with regular pulse or (ir)regularly irregular pulse
- Bradycardia with regular pulse or (ir)regularly irregular pulse
- Tachypnea / bradypnea
- Kussmal respirations may be present
- Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse may be present
- High/low blood pressure with normal pulse pressure / wide pulse pressure / narrow pulse pressure may be present
Skin
- Skin examination of patients with hyponatremia varies depend on the underlying causes like hypothyroidism, CHF, adrenal insufficeincy
OR
-
Description (Adapted from Dermatology Atlas)
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Description (Adapted from Dermatology Atlas)
HEENT
- HEENT examination of patients with hyponatremia varies depending on the causes: tumor, thyriod diseases
- Abnormalities of the head/hair may include hair loss, brittle hair
- Evidence of trauma
- Icteric sclera
- Nystagmus
- Extra-ocular movements may be abnormal in case of tumor associated hyponatremia
- Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
- Ophthalmoscopic exam may be abnormal with findings of brain edema
- Hearing acuity may be reduced
- Weber test may be abnormal
- Rinne test may be positive
- Facial tenderness
- Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
Neck
- Neck examination of patients with hyponatremia may lead to other causes like tumors
- Jugular venous distension
- Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
- Lymphadenopathy (describe location, size, tenderness, mobility, and symmetry)
- Thyromegaly / thyroid nodules
- Hepatojugular reflux
Lungs
- Pulmonary examination of patients with severe hyponatremia
- Asymmetric chest expansion / Decreased chest expansion
- Lungs can be hypporesonant/hyperresonant
- Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
- Rhonchi
- Vesicular breath sounds / Distant breath sounds
- Expiratory/inspiratory wheezing with normal / delayed expiratory phase
- Wheezing may be present
- Egophony present may be present
- Bronchophony present may be present
- Reduced tactile fremitus may be present
Heart
- Cardiovascular examination of patients with hyponatremia
- Chest tenderness upon palpation may be present
- PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of
- Heave / thrill
- Friction rub
- S1
- S2
- S3
- S4
- Gallops
- A high/low grade early/late systolic murmur / diastolic murmur may be heard .
Abdomen
- Abdominal distention
- Abdominal tenderness in the right/left upper/lower abdominal quadrant
- Rebound tenderness (positive Blumberg sign)
- A palpable abdominal mass in the right/left upper/lower abdominal quadrant
- Guarding may be present
- Hepatomegaly / splenomegaly / hepatosplenomegaly
- Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
Back
- Point tenderness over vertebrae
- Sacral edema
- Costovertebral angle tenderness bilaterally/unilaterally
- Buffalo hump
Genitourinary
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
Neuromuscular
- Patient can be oriented to persons, place, and time
- Altered mental status
- Glasgow coma scale has to be checked
- Hyperreflexia / hyporeflexia / areflexia
- Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
- Muscle rigidity
- Proximal/distal muscle weakness unilaterally/bilaterally
- In case of brain edema or heniation involvement of cranial nerves may be seen
- Unilateral/bilateral upper/lower extremity weakness
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Positive straight leg raise test
- Abnormal gait ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait may be present
- Positive/negative Trendelenburg sign
- Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
- Normal finger-to-nose test / Dysmetria my be present
Extremities
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity