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: Iqra Qamar M.D.[2] Saeedeh Kowsarnia 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	Volume status	JVP	Edema	Crackles	Ascites	Tachycardia	Hypotension	Dry mucous membranes	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%	-	-