Hyponatremia laboratory findings: Difference between revisions

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==Overview==
==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
* Serum cortisol
* Adrenocorticotropine hormone
* ADH level
* TSH
* Urine sodium
* Urine chloride
* Urine osmolality
* Urine for other solutes
* Fraction excretion of sodium
* Calculated GFR
}}
For different causes of hyponatremia, click [[Hyponatremia causes#Causes|here]].


For approach to differential diagnosis, click [[Hyponatremia differential diagnosis#Differentiating etiologies of Hyponatremia|here]].
| doi = 10.1016/j.amjmed.2010.01.013


For the clinical approach to diagnosis, click [[Hyponatremia diagnostic study of choice#Diagnostic Approach to Hyponatremia|here]].
| pmid = 20609688


<br>
}}</ref>''':'''
<small>
{| class="wikitable"
{| class="wikitable"
!Conditions
!Conditions
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|> 100 mOsm/kg
|> 100 mOsm/kg
|'''U<sub>Na</sub> > 20 mEq/L:'''
|'''U<sub>Na</sub> > 20 mEq/L:'''
* Acute or chronic renal failure
*Acute or chronic [[renal failure]]
 
*Fluid overload
*[[Psychogenic polydipsia]]
*[[Diuretic]] use in: [[Heart failure]]  [[Liver disease|, Liver disease]], [[Nephrotic syndrome]]


* Fluid overload
* Psychogenic polydipsia
* [[Diuretic]] use in: [[Heart failure]]  [[Liver disease|, Liver disease]], [[Nephrotic syndrome]]
'''U<sub>Na</sub> < 20 mEq/L:'''
'''U<sub>Na</sub> < 20 mEq/L:'''
* Heart failure


* Cirrhosis
*[[Heart failure]]
*[[Primary polydipsia]]
 
*[[Cirrhosis]]


* Nephritic/nephrotic syndrome
*Nephritic/[[nephrotic syndrome]]
|-
|-
!Euvolemic hyponatremia
!<big>Euvolemic hyponatremia</big>
|TBW ↑
|TBW ↑
Serum Na  ↔
Serum Na  ↔
Line 87: Line 80:
|> 100 mOsm/kg
|> 100 mOsm/kg
|'''Variable U<sub>Na</sub>''' ''':'''
|'''Variable U<sub>Na</sub>''' ''':'''
* SIAD/ SIADH
*[[SIADH|SIAD]]/ SIADH with fluid restriction
*[[Hypothyroidism]]
 
'''U<sub>Na</sub> > 40 mEq/L:'''
'''U<sub>Na</sub> > 40 mEq/L:'''
* Cortisol deficiency


* Hypothyroidism
*[[Cortisol]] deficiency
* Drugs
*[[ACTH]] deficiency
* SIAD/ SIADH
 
*[[Hypothyroidism]]
*Drugs
*[[SIADH|SIAD]]/ SIADH
|-
|-
!Hypovolemic hyponatremia
!<big>Hypovolemic hyponatremia</big>
|TBW ↔
|TBW ↔
Serum Na  ↓↓
Serum Na  ↓↓
Line 101: Line 98:
|> 500 mOsm/kg
|> 500 mOsm/kg
|'''U<sub>Na</sub> > 30 mEq/L:'''
|'''U<sub>Na</sub> > 30 mEq/L:'''
* Renal loss:
*Renal loss:
** [[Osmotic diuresis]] ([[glucose]], [[urea]], bicarbonaturia)
**[[Osmotic diuresis]] ([[glucose]], [[urea]], bicarbonaturia)
** Salt-Iosing nephropathy
**[[Salt-Iosing nephropathy]]
** [[Addison disease]]
**[[Addison disease]]
** [[Cerebral salt wasting syndrome|CSW]]
**[[Cerebral salt wasting syndrome|CSW]]
** Diuretics
**[[Diuretics]]
 
'''U<sub>Na</sub> < 30 mEq/L:'''
'''U<sub>Na</sub> < 30 mEq/L:'''
* Diuretics


* Extra renal loss:
*[[Diuretics]]
** [[Vomiting]] (U<sub>cl</sub> ↓)
 
** [[Diarrhea]]
*Extra renal loss:
** [[Pancreatitis]]
**[[Vomiting]] (U<sub>cl</sub> ↓)
** [[Sweating]]
**[[Diarrhea]]
** Small bowel obstruction
**[[Pancreatitis]]
**[[Sweating]]
**[[Small bowel obstruction]]
|}
|}
</small>


==References==
==References==

Latest revision as of 20:26, 2 July 2021

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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]

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 UNa > 20 mEq/L:

UNa < 20 mEq/L:

Euvolemic hyponatremia TBW ↑

Serum Na ↔

< 275 mOsm/kg > 100 mOsm/kg Variable UNa :

UNa > 40 mEq/L:

Hypovolemic hyponatremia TBW ↔

Serum Na ↓↓

< 275 mOsm/kg > 500 mOsm/kg UNa > 30 mEq/L:

UNa < 30 mEq/L:

References

  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)

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