Hyponatremia laboratory findings: Difference between revisions

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Latest revision as of 20:26, 2 July 2021

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

Overview

In hyponatremia, depending on the cause, there can be different laboratory abnormalities.

To see the causes of hyponatremia, click here.

To see the differential diagnosis of hyponatremia, click here.

Laboratory Findings

Biochemical evaluation for finding the etiologies of hyponatremia :

CT scan for brain chest abdomen and pelvis is necessary for patients to evaluate the causes like SIAD( tumor detection ), and differentiate from other causes with the same presentation.

For different causes of hyponatremia, click here.

For approach to differential diagnosis, click here.

For the clinical approach to diagnosis, click here.

Laboratory findings in different causes of hyponatremia ^[1]:

Conditions	Sodium status	Plasma osmolality	Urine osmolality	Differentiation of causes
Hypervolemic hyponatremia	TBW ↑↑ Serum Na ↑	< 275 mOsm/kg	> 100 mOsm/kg	U_Na > 20 mEq/L: Acute or chronic renal failure Fluid overload Psychogenic polydipsia Diuretic use in: Heart failure , Liver disease, Nephrotic syndrome U_Na < 20 mEq/L: Heart failure Primary polydipsia Cirrhosis Nephritic/nephrotic syndrome
Euvolemic hyponatremia	TBW ↑ Serum Na ↔	< 275 mOsm/kg	> 100 mOsm/kg	Variable U_Na : SIAD/ SIADH with fluid restriction Hypothyroidism U_Na > 40 mEq/L: Cortisol deficiency ACTH deficiency Hypothyroidism Drugs SIAD/ SIADH
Hypovolemic hyponatremia	TBW ↔ Serum Na ↓↓	< 275 mOsm/kg	> 500 mOsm/kg	U_Na > 30 mEq/L: Renal loss: Osmotic diuresis (glucose, urea, bicarbonaturia) Salt-Iosing nephropathy Addison disease CSW Diuretics U_Na < 30 mEq/L: Diuretics Extra renal loss: Vomiting (U_cl ↓) Diarrhea Pancreatitis Sweating Small bowel obstruction

References

↑ Wiebke Fenske, Sebastian K. G. Maier, Anne Blechschmidt, Bruno Allolio & Stefan Stork (2010). "Utility and limitations of the traditional diagnostic approach to hyponatremia: a diagnostic study". The American journal of medicine. 123 (7): 652–657. doi:10.1016/j.amjmed.2010.01.013. PMID 20609688. Unknown parameter |month= ignored (help)

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[1] Wiebke Fenske, Sebastian K. G. Maier, Anne Blechschmidt, Bruno Allolio & Stefan Stork (2010). "Utility and limitations of the traditional diagnostic approach to hyponatremia: a diagnostic study". The American journal of medicine. 123 (7): 652–657. doi:10.1016/j.amjmed.2010.01.013. PMID 20609688. Unknown parameter |month= ignored (help)

[1]

@@ Line 5: / Line 5: @@
 ==Overview==
-An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
+In hyponatremia, depending on the cause, there can be different laboratory abnormalities.
-OR
+To see the causes of hyponatremia, click [[Hyponatremia causes#Causes|here]].
-Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
+To see the differential diagnosis of hyponatremia, click [[Hyponatremia differential diagnosis#Differentiating etiologies of Hyponatremia|here]].
-OR
+==Laboratory Findings==
+'''Biochemical evaluation for finding the etiologies of hyponatremia :'''
+*CT scan for brain chest abdomen and pelvis is necessary for patients to evaluate the causes like SIAD( tumor detection ), and differentiate from other causes with the same presentation.
-[Test] is usually normal among patients with [disease name].
+For different causes of hyponatremia, click [[Hyponatremia causes#Causes|here]].
-OR
+For approach to differential diagnosis, click [[Hyponatremia differential diagnosis#Differentiating etiologies of Hyponatremia|here]].
-Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
+For the clinical approach to diagnosis, click [[Hyponatremia diagnostic study of choice#Diagnostic Approach to Hyponatremia|here]].
-OR
+<br>'''Laboratory findings in different causes of hyponatremia '''<ref>{{Cite journal
-There are no diagnostic laboratory findings associated with [disease name].
+ | author = [[Wiebke Fenske]], [[Sebastian K. G. Maier]], [[Anne Blechschmidt]], [[Bruno Allolio]] & [[Stefan Stork]]
-==Laboratory Findings==
+ | title = Utility and limitations of the traditional diagnostic approach to hyponatremia: a diagnostic study
-'''Biochemical evaluation for finding the etiologies of hyponatremia :'''
-{{Columns-list|2|
+ | journal = [[The American journal of medicine]]
-* Serum sodium
-* Serum osmolality
+ | volume = 123
-* Serum potassium
-* Serum chloride
+ | issue = 7
-* Serum creatinine
-* Serum other solutes
+ | pages = 652–657
-* Serum urea
-* Blood Glucose
+ | year = 2010
-* Total protein and albumin
-* Serum lipids
+ | month = July
-* Total bilirubin and direct bilirubin
-* Red and white cell blood count
+ | doi = 10.1016/j.amjmed.2010.01.013
-* Serum cortisol
-* Adrenocorticotropine hormone
-* ADH level
-* TSH
-* Urine sodium
-* Urine chloride
-* Urine osmolality
-* Urine for other solutes
-* Fraction excretion of sodium
-* Calculate GFR
-}}
-For approach to differential diagnosis click [[Hyponatremia differential diagnosis#Differentiating etiologies of Hyponatremia|here]].
-For clinical approach to diagnosis click [[Hyponatremia diagnostic study of choice#Diagnostic Approach to Hyponatremia|here]].
+ | pmid = 20609688
-<br>
+}}</ref>''':'''
+<small>
 {| class="wikitable"
-!Characteristics
+!Conditions
-!Hypervolemic
+!Sodium status
-Hyponatremia
+!Plasma osmolality
-!Euvolemic
+!Urine osmolality
-Hyponatremia
+!Differentiation of causes
-!Hypovolemic
-Hyponatremia
 |-
-!Total body water
+!<big>Hypervolemic hyponatremia</big>
-|↑↑
+|TBW ↑↑
-|↑
+Serum Na  ↑
-|↔
+|< 275 mOsm/kg
-|-
+|> 100 mOsm/kg
-!Serum sodium level
+|'''U<sub>Na</sub> > 20 mEq/L:'''
-|↑
+*Acute or chronic [[renal failure]]
-|↔
-|↓↓
+*Fluid overload
-|-
+*[[Psychogenic polydipsia]]
-!Plasma Osmolality, mOsm/kg
+*[[Diuretic]] use in: [[Heart failure]]  [[Liver disease|, Liver disease]], [[Nephrotic syndrome]]
-|< 280
-|<280
+'''U<sub>Na</sub> < 20 mEq/L:'''
-|≥ 280
-|-
+*[[Heart failure]]
-!Urine Osmolality, mOsm/L
+*[[Primary polydipsia]]
-|> 100
-|> 100
-|> 500
-|-
-!Urine sodium level, mEq/L
-|< 20 or >20
-|> 20
-|< 10 or > 20
-|-
-!Differentiation of causes
-|'''> 20 mEq/L urinary sodium:'''
-* Acute or chronic renal failure
-* Fluid overload
+*[[Cirrhosis]]
-* Psychogenic polydipsia
-'''< 20 mEq/L urinary sodium:'''
-* Heart failure
-* Cirrhosis
+*Nephritic/[[nephrotic syndrome]]
+|-
+!<big>Euvolemic hyponatremia</big>
+|TBW ↑
+Serum Na  ↔
+|< 275 mOsm/kg
+|> 100 mOsm/kg
+|'''Variable U<sub>Na</sub>''' ''':'''
+*[[SIADH|SIAD]]/ SIADH with fluid restriction
+*[[Hypothyroidism]]
-* Nephritic syndrome
+'''U<sub>Na</sub> > 40 mEq/L:'''
-|
-* SIADH/SIAD
-* Adrenal insufficiency
+*[[Cortisol]] deficiency
+*[[ACTH]] deficiency
-* Hypothyroidism
+*[[Hypothyroidism]]
-* Drugs
+*Drugs
-|'''< 10 mEq/L urinary sodium:'''
+*[[SIADH|SIAD]]/ SIADH
-* Diuretics
+|-
-* Extrarenal loss such as diarrhea, vomiting
+!<big>Hypovolemic hyponatremia</big>
+|TBW ↔
+Serum Na  ↓↓
+|< 275 mOsm/kg
+|> 500 mOsm/kg
+|'''U<sub>Na</sub> > 30 mEq/L:'''
+*Renal loss:
+**[[Osmotic diuresis]] ([[glucose]], [[urea]], bicarbonaturia)
+**[[Salt-Iosing nephropathy]]
+**[[Addison disease]]
+**[[Cerebral salt wasting syndrome|CSW]]
+**[[Diuretics]]
-* Severe hyperglycemia
+'''U<sub>Na</sub> < 30 mEq/L:'''
-* Third spacing of fluids
-'''> 20 mEq/L urinary sodium:'''
-* Adrenal insufficiency
-* Renal bicarbonate loss(renal tubal acidosis,
+*[[Diuretics]]
-metabolic alkalosis)
-* Renal sodium loss (cerebral salt wasting, salt-wasting nephropathy)
-* Diuretics
+*Extra renal loss:
+**[[Vomiting]] (U<sub>cl</sub> ↓)
+**[[Diarrhea]]
+**[[Pancreatitis]]
+**[[Sweating]]
+**[[Small bowel obstruction]]
 |}
-*There are no diagnostic laboratory findings associated with [disease name].
+</small>
-OR
-*An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
-*[Test] is usually normal among patients with [disease name].
-*Laboratory findings consistent with the diagnosis of [disease name] include:
-**[Abnormal test 1]
-**[Abnormal test 2]
-**[Abnormal test 3]
-*Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 ==References==

Hyponatremia laboratory findings: Difference between revisions

Latest revision as of 20:26, 2 July 2021

Overview

Laboratory Findings

References

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