Diagnosis and Treatment of Hyponatremia

Posted by e-Medical PPT
Major Causes of Hyponatremia
EIVF Depletion
True Volume Depletion
CHF or Cirrhosis
SIADH(Syndrome of Inappropriate ADH Release)
Hormone mediated
Adrenal Insufficiency
Hypothyroidism
Pregnancy
Disorders in which ADH levels may be appropriately suppressed
Advanced renal failure
Primary polydipsia
Beer drinker’s potomania
Pseudohyponatremia
High plasma osmolality:  hyperglycemia, mannitol, urea
Normal plasma osmolality:  hyperlipidemia, hyperproteinemia, glycine infusion.

Causes of Hypoosmolality
Volume Depletion
GI, lung or skin losses
Third space sequestration 
Adrenal insufficiency
Renal salt wasting
Cerebral salt wasting
Volume Expansion
CHF, cirrhosis with ascites, nephrotic syndrome
Euvolemic
SIADH, water intoxication, reset osmostat, drugs

Syndrome of Inappropriate ADH Release (Bartter’s Criteria)
Hyponatremia and true hypoosmolality by definition
Euvolemia clinical
Urine less than maximally dilute (urinary osmolality usually > 200 mOsm/kg of H2O)
Normal renal, cardiac, hepatic, adrenal, pituitary, and thyroid function
No history of antidiuretic drugs
No emotional or physical stress
Urinary sodium >20 mEq/litera

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