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
	Symptoms and Signs												Lab Findings
	Muscle weakness/ Cramps	Oliguria	Vomiting/ Diarrhea	Confusion/ Dizziness	Volume status	JVP	Edema	Crackles	Ascites	Tachycardia	Hypotension	Dry mucous membranes	CBC	Urine Analysis			Serum Osmolality	ADH levels
														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 ↑