Central pontine myelinolysis laboratory findings: Difference between revisions
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*Hypoosmotic [[hyponatremia]] | *Hypoosmotic [[hyponatremia]] | ||
**The rapid correction of [[hyponatremia]] is the cause of central pontine myelinolysis. | **The rapid correction of [[hyponatremia]] is the cause of central pontine myelinolysis. | ||
*[ | **The Common causes of [[hyponatremia]] include: | ||
*[ | **** '''<big>Etiologies of SIAD:</big>''' | ||
{| class="wikitable" | |||
! colspan="2" |'''<big>Conditions</big>''' | |||
|- | |||
!<big>Malignant disorders</big> | |||
|'''Carcinoma:''' Lung ( [[small cell carcinoma]], [[mesothelioma]]), oropharynx, stomach, duodenum, pancreas, ureter, bladder, prostate, endometrium, [[thymoma]] | |||
'''Lymphomas''' | |||
'''Sarcomas:''' [[Ewing's sarcoma]] | |||
'''Olfactory neuroblastoma''' | |||
|- | |||
!<big>Pulmonary diseases</big> | |||
|'''Infections:''' [[Bacterial pneumonia]], [[viral pneumonia]], [[pulmonary abscess]], [[tuberculosis]], [[aspergillosis]] | |||
'''Others:''' [[Asthma]], [[cystic fibrosis]], [[respiratory failure]], [[emphysema]], [[COPD]], positive-pressure ventilation | |||
|- | |||
!<big>CNS disorders</big> | |||
|'''Infections:''' Encephalitis, meningitis, brain abscess, [[RMSF]], [[AIDS]], [[malaria]] | |||
'''Vascular and SOP:''' [[Subarachnoid hemorrhage]], [[stroke]], [[brain tumors]], [[head trauma]] | |||
'''Others:''' [[Hydrocephalus]], [[cavernous sinus thrombosis]], [[Multiple sclerosis]], Guillain–Barré syndrome, Shy–Drager syndrome, | |||
[[delirium tremens]], [[Acute intermittent porphyrias|acute intermittent porphyria]], chronic psychosis, pituitary stalk section, transsphenoidal adenomectomy | |||
|- | |||
!<big>Other causes</big> | |||
|'''Hereditary:''' Gain-of-function mutation of V2 receptors | |||
'''Idiopathic''' | |||
'''[[#Drugs cause hyponatremia|Drugs]]''' | |||
'''Transient:''' [[Exercise]], [[general anesthesia]], nausea, pain, stress | |||
|} | |||
<br> | |||
* Causes of '''<big>acute hyponatremia:</big>''' | |||
{| class="wikitable" | |||
!Etiology | |||
|- | |||
| | |||
* Post operative phase | |||
* Transurethral or endoscopic procedure (mannitol, sorbitol, glycine) | |||
* Colonoscopy preparation | |||
* Polydipsia | |||
* Exercise | |||
* Oxytocin | |||
* Cyclophosphamide | |||
* Ecstasy( 3,4-Methylenedioxymethamphetamine, MDMA) | |||
* Thiazide | |||
* Halopridol | |||
* Recently started desmopressin, terlipressin, vasopressin | |||
|} | |||
<small>( Etiologies that cause hyperacute and acute hyponatremia are applicable to each category interchangeably depending on the onset of symptoms)</small> | |||
<br> | |||
* Causes of '''<big>Hyponatremia</big>''' based upon '''Serum Osmolality:''' | |||
{| class="wikitable" | |||
!Classification | |||
!Serum Osmolality | |||
!Etiology | |||
|- | |||
|'''<big>Hypertonic or Isotonic Hyponatremia</big>''' | |||
|> 295 mOsm/kg | |||
|[[Hyperglycemia]]<sup>‡</sup>, [[Mannitol]], [[Glycine]], [[Maltose]], severe [[azotemia]] | |||
|- | |||
|'''<big>Isotonic Hyponatremia</big>''' | |||
'''(Pseudohyponatremia)''' | |||
|275 – 295 mOsm/kg | |||
|Lab/blood draw error, Post TURP (bladder irrigation with osmotic solutions), | |||
intravenous immunoglobulin (IVIg), Hyperlipidemia ( triglyceride, cholesterol ), | |||
hyper paraproteinemia (monoclonal gammopathy of undetermined significance (MGUS), | |||
multiple myeloma), | |||
|- | |||
|'''<big>Hypotonic Hyponatremia</big>''' | |||
|< 275 mOsm/kg | |||
|[[Glycerol]], [[Sorbitol]], Etiology depends upon volume status (Hypervolemic/ Euvolemic/ Hypovolemic) | |||
|- | |||
| colspan="3" |<small>[[Alcohol]], [[Urea]], Ethylen glycol are ineffective osmoles, cause hyperosmolar isotonic serum but not hyponatremia.</small> | |||
|} | |||
<small>‡ Hyperglycemia causes osmotic diuresis results in a rise in serum sodium concentration, on the other hand it leads to extracellular shift of water due to osmotic gradient which causes relative hyponatremia , depends on which effect is stronger, there would be hypertonicity or hypotonicity<ref>{{Cite journal | |||
| author = [[A. I. Arieff]] & [[H. J. Carroll]] | |||
| title = Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases | |||
| journal = [[Medicine]] | |||
| volume = 51 | |||
| issue = 2 | |||
| pages = 73–94 | |||
| year = 1972 | |||
| month = March | |||
| pmid = 5013637 | |||
}}</ref>.</small> | |||
* Causes of '''<big>Hyponatremia</big>''' based on '''volume status''' '''<ref name="GuillauminDiBartola2017">{{cite journal|last1=Guillaumin|first1=Julien|last2=DiBartola|first2=Stephen P.|title=A Quick Reference on Hyponatremia|journal=Veterinary Clinics of North America: Small Animal Practice|volume=47|issue=2|year=2017|pages=213–217|issn=01955616|doi=10.1016/j.cvsm.2016.10.003}}</ref> :''' | |||
{| class="wikitable" | |||
!Volume status | |||
!Sodium status | |||
!Causes | |||
|- | |||
|'''<big>Hypovolemic</big>''' | |||
'''<big>Hyponatremia<ref name="Rondon-BerriosAgaba2014">{{cite journal|last1=Rondon-Berrios|first1=Helbert|last2=Agaba|first2=Emmanuel I.|last3=Tzamaloukas|first3=Antonios H.|title=Hyponatremia: pathophysiology, classification, manifestations and management|journal=International Urology and Nephrology|volume=46|issue=11|year=2014|pages=2153–2165|issn=0301-1623|doi=10.1007/s11255-014-0839-2}}</ref>''' | |||
| | |||
* total body water ↓ | |||
* total body sodium ↓↓ | |||
| | |||
* '''GI loss:''' [[Vomiting]], [[Diarrheal|diarrhea]], tube drainage | |||
* '''Insensible loss:''' [[Sweating]], [[burns]] | |||
* '''Renal loss:''' Salt-wasting nephropathy (inappropriate loss of Na+-Cl– in the urine), | |||
bicarbonaturia ( renal tubular acidosis, metabolic alkalosis), [[osmotic diuresis]], [[diuretic use]], | |||
[[cerebral salt-wasting syndrome]] ([[Stroke]] ,[[SAH]] ,↑ [[brain natriuretic peptide]] and ↑ renal sodium loss ) | |||
* '''Third spacing of fluids :''' [[Pancreatitis]], [[hypoalbuminemia]], [[Small bowel obstruction]] | |||
* '''Mineralocorticoid deficiency:''' [[Addison disease]] (primary) | |||
* '''Excessive diuretic administration''' | |||
|- | |||
|'''<big>Hypervolemic</big>''' | |||
'''<big>Hyponatremia</big>''' | |||
| | |||
* total body water '''↑↑''' | |||
* total body sodium ↑ | |||
| | |||
* '''Renal disease:''' Acute or chronic kidney disease or injury | |||
(due to relatively higher water versus salt intake and poor excretion), nephrotic syndrome | |||
* '''Congestive heart failure''' | |||
* '''Cirrhosis''' | |||
* '''Iatrogenic''' | |||
|- | |||
|'''<big>Euvolemic</big>''' | |||
'''<big>Hyponatremia</big>''' | |||
| | |||
* total body water ↑ | |||
* total body sodium ↔ | |||
| | |||
* '''Drugs:''' [[Vasopressin]], [[diuretics]], [[antidepressants]], [[opioids]] | |||
* '''SIAD:''' [[SIADH]] (Malignancy, central nervous system (CNS) disorders, pulmonary disease, or drugs, | |||
postoperative nausea, pain, stress, neoplasia (common), trauma, pregnancy) | |||
''',''' nephrogenic SIAD (Gain-of-function mutation of v2 receptors) | |||
* '''High fluid intake:''' Physical activity, surgery, primary polydipsia, potomania, tea & toast diet | |||
(caused by a low intake of solutes with relatively high fluid intake) | |||
* '''Medical testing''' (excess fluid intake) ''':'''[[Colonoscopy]] or [[cardiac catheterization]] | |||
* '''Hypothyroidism''' | |||
* '''Hormonal:''' [[Glucocorticoid deficiency 1|Glucocorticoid deficiency]], [[pituitary failure]] (secondary), hypothalamic failure (tertiary) | |||
* '''Reset osmostat <sup>†</sup> :''' Drugs, pregnancy | |||
* '''Iatrogenic''' | |||
|} | |||
''<small>† Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors</small>'' | |||
<br> | |||
* <big>'''Drugs''' which cause '''hyponatremia:'''</big> | |||
{| class="wikitable" | |||
!'''<big>Drug Mechanisms <ref name="LiamisMilionis200822">{{cite journal|last2=Milionis|first2=Haralampos|last3=Elisaf|first3=Moses|year=2008|title=A Review of Drug-Induced Hyponatremia|journal=American Journal of Kidney Diseases|volume=52|issue=1|pages=144–153|doi=10.1053/j.ajkd.2008.03.004|issn=02726386|last1=Liamis|first1=George}}</ref></big>''' | |||
!'''<big>Drug Classification</big>''' | |||
|- | |||
!'''<big>Increase ADH secretion</big>''' | |||
|'''Antidepressants:'''[[Tricyclic antidepressants]] ( [[Amitryptiline]], | |||
[[Protriptyline]], [[Desipramine]]),[[Selective serotonin reuptake inhibitors]], | |||
[[Monoamine oxidase inhibitors]] | |||
'''Antipsychotic drugs:''' [[Phenothiazines]] ([[Thioridazine]], [[Trifluoperazine]]), | |||
[[Butyrophenones]] ([[Haloperidol]]) | |||
'''Antiepileptic drugs:''' [[Carbamazepine]], [[Oxcarbazepine]], [[Sodium valproate]] | |||
'''Anticancer agents:''' [[Vinca alkaloids]] ([[Vincristine]], [[Vinblastine]]), | |||
Platinum compounds ([[Cisplatinum|Cisplatin]], [[Carboplatinum|Carboplatin]]) | |||
'''Alkylating agents:''' Intravenous [[Cyclophosphamide lyophilized|Cyclophosphamide]], [[Melphalan]], [[Ifosfamide]] | |||
'''Miscellaneous:''' [[Methotrexate Sodium|Methotrexate]], [[Interferon]], [[Levamisole]], [[Pentostatin]], [[Monoclonal antibodies]], [[MDMA]], [[Nicotine]] | |||
'''Opiates''' | |||
|- | |||
!<big>Increase ADH effect</big> | |||
|'''Antiepileptic drugs:''' [[Carbamazepine]], [[Lamotrigine]] | |||
'''Antidiabetic drugs:''' [[Chlorpropamide]], [[Tolbutamide]] | |||
'''Anticancer agents:''' Alkylating agents (Intravenous [[Cyclophosphamide lyophilized|cyclophosphamide]]) | |||
'''NSAIDS''' | |||
|- | |||
!<big>Drugs affecting water and sodium homeostasis</big> | |||
|'''Diuretics:''' [[Thiazides]], [[Indapamide]], [[Amiloride]], [[Loop diuretics]] | |||
|- | |||
!<big>Reset omostat <sup>‡</sup></big> | |||
|'''Antidepressants:''' [[Venlafaxine]] | |||
'''Antiepileptic drugs:''' [[Carbamazepine]] | |||
|- | |||
!<big>Vasopressin analogues</big> | |||
|[[Desmopressin]], [[oxytocin]], [[terlipressin]], [[Vasopressin analogue|vasopressin]] | |||
|} | |||
<small>‡ ''Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors'' | |||
<br> | |||
</small> | |||
<br> | |||
===Causes by Organ System=== | |||
{| style="width:80%; height:100px" border="1" | |||
| style="width:25%" bgcolor="lightsteelblue" ; border="1" | '''Cardiovascular''' | |||
| style="width:75%" bgcolor="beige" ; border="1" | [[Congestive heart failure ]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Chemical / poisoning''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Dermatologic''' | |||
| bgcolor="beige" | [[Burns]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Drug Side Effect''' | |||
| bgcolor="beige" | [[ACE inhibitors]], [[Ajuga nipponensis makino ]] , [[Asenapine maleate]], [[Cefpodoxime]], [[Chlorpropamide]], [[Cyclophosphamide]], [[Desmopressin]], [[Diuretics]], [[Duloxetine]], [[Eslicarbazepine acetate]], [[Ethacrynic Acid]], [[Felbamate]], [[Fluvoxamine]], [[Interferon gamma]], [[Ixabepilone]], [[Losartan and Hydrochlorothiazide]], [[Nilotinib]], [[Nivolumab]], [[Nonsteriodal anti-inflammatory drugs ]] , [[Oxcarbazepine]], [[Pramipexole]], [[Rifaximin]], [[Tiagabine]], [[Tolazamide]], [[Zonisamide]], [[Tolbutamide]], [[Vortioxetine]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Ear Nose Throat''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Endocrine''' | |||
| bgcolor="beige" | [[Addison's disease]], [[Corticosterone methyloxidase type I deficiency ]] , [[Diabetes mellitus]], [[Diabetic coma]], [[Glucocorticoid deficiency]], [[Familial hyperreninemic hypoaldosteronism type 2]], [[Hypothyroidism]], [[Mineralocorticoid deficiency]], [[Myxedema coma ]] , [[Syndrome of inappropriate antidiuretic hormone ]] , [[Thyrotropin deficiency]], [[18-Hydroxylase deficiency ]] , [[Familial hypoaldosteronism ]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Environmental''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Gastroenterologic''' | |||
| bgcolor="beige" | [[Acute liver failure ]] , [[Cirrhosis]], [[Congenital chloride diarrhea ]] , [[Diarrhea]], [[Gastrointestinal fistula]], [[Ileus]], [[Necrotizing enterocolitis ]] , [[Pancreatitis]], [[Peritonitis]], [[Vomiting]], [[Cystic fibrosis]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Genetic''' | |||
| bgcolor="beige" | [[18-Hydroxylase deficiency ]] , [[Bartter Syndrome type 4 ]] , [[Cystic fibrosis]], [[Familial hypoaldosteronism ]] , [[Corticosterone methyloxidase type I deficiency ]] , [[Familial hyperreninemic hypoaldosteronism type 2]], [[Congenital chloride diarrhea ]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Hematologic''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Iatrogenic''' | |||
| bgcolor="beige" | [[After pituitary surgery]], [[After surgery]], [[Ascitic tap]], [[Gastric drainage]], [[Hypotonic infusions]], [[Pleuracentesis]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Infectious Disease''' | |||
| bgcolor="beige" | [[Malignant boutonneuse fever ]] , [[Neonatal bacterial meningitis ]] , [[Peritonitis]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Musculoskeletal / Ortho''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Neurologic''' | |||
| bgcolor="beige" | [[Intracranial hemorrhage]], [[Subarachnoid hemorrhage]], [[Pituitary cancer]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Nutritional / Metabolic''' | |||
| bgcolor="beige" | [[Hyperlipidemia]], [[Hyperproteinemia]], [[Hypoalbuminemia]], [[Low sodium diet]], [[Metabolic acidosis]], [[Diabetic coma]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Obstetric/Gynecologic''' | |||
| bgcolor="beige" | [[Pregnancy]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Oncologic''' | |||
| bgcolor="beige" | [[Pituitary cancer]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Opthalmologic''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Overdose / Toxicity''' | |||
| bgcolor="beige" | [[Water intoxication]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Psychiatric''' | |||
| bgcolor="beige" | [[Psychogenic polydipsia]], [[Psychosis]], [[Self-induced water intoxication and schizophrenic disorders syndrome ]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Pulmonary''' | |||
| bgcolor="beige" | [[Cystic fibrosis]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Renal / Electrolyte''' | |||
| bgcolor="beige" | [[Acute kidney disease]], [[Chronic kidney disease]], [[Diuresis]], [[Glucosuria]], [[Ketonuria]], [[Nephrotic syndrome]], [[Renal Tubular Acidosis]], [[Tubulointerstitial kidney disease]], [[Bartter Syndrome type 4 ]] , [[Corticosterone methyloxidase type I deficiency ]] , [[Renal failure]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Rheum / Immune / Allergy''' | |||
| bgcolor="beige" | [[Addison's disease]], [[Nephrotic syndrome]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Sexual''' | |||
| bgcolor="beige" | [[Cystic fibrosis]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Trauma''' | |||
| bgcolor="beige" | [[Burns]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Urologic''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Dental''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Miscellaneous''' | |||
| bgcolor="beige" | [[Beer potomania]], [[Ecstasy abuse ]] , [[Factitious hyponatremia]], [[Hydration]], [[Massive edema]], [[Pseudohyponatremia]], [[Water Intoxication ]] , [[Hyperlipidemia]], [[Hyperproteinemia]], [[Hypoalbuminemia]], [[Exercise associated hyponatremia]] | |||
|- | |||
|} | |||
=== Causes in Alphabetical Order=== | |||
{{MultiCol}} | |||
*[[18-Hydroxylase deficiency ]] | |||
*[[ACE inhibitors]] | |||
*[[Acute kidney disease]] | |||
*[[Acute liver failure ]] | |||
*[[Addison's disease]] | |||
*[[After pituitary surgery]] | |||
*[[After surgery]] | |||
*[[Ajuga nipponensis makino ]] | |||
*[[Ascitic tap]] | |||
*[[Bartter Syndrome type 4 ]] | |||
*[[Beer potomania]] | |||
*[[Burns]] | |||
*[[Chronic kidney disease]] | |||
*[[Cirrhosis]] | |||
*[[Congenital chloride diarrhea ]] | |||
*[[Congestive heart failure ]] | |||
*[[Corticosterone methyloxidase type I deficiency ]] | |||
*[[Cyclophosphamide]] | |||
*[[Cystic fibrosis]] | |||
*[[Desmopressin]] | |||
*[[Diabetes mellitus]] | |||
*[[Diabetic coma]] | |||
*[[Diarrhea]] | |||
*[[Diuresis]] | |||
*[[Diuretics]] | |||
*[[Ecstasy abuse ]] | |||
*[[Exercise associated hyponatremia]] | |||
*[[Factitious hyponatremia]] | |||
*[[Familial hypoaldosteronism ]] | |||
*[[Familial hyperreninemic hypoaldosteronism type 2]] | |||
*[[Gastric drainage]] | |||
*[[Gastrointestinal fistula]] | |||
*[[Glucocorticoid deficiency]] | |||
*[[Glucosuria]] | |||
*[[Hydration]] | |||
*[[Hyperlipidemia]] | |||
{{ColBreak}} | |||
*[[Hyperproteinemia]] | |||
*[[Hypoalbuminemia]] | |||
*[[Hypothyroidism]] | |||
*[[Hypotonic infusions]] | |||
*[[Ileus]] | |||
*[[Interferon gamma]] | |||
*[[Intracranial hemorrhage]] | |||
*[[Ketonuria]] | |||
*[[Low sodium diet]] | |||
*[[Malignant boutonneuse fever ]] | |||
*[[Massive edema]] | |||
*[[Metabolic acidosis]] | |||
*[[Mineralocorticoid deficiency]] | |||
*[[Myxedema coma ]] | |||
*[[Necrotizing enterocolitis ]] | |||
*[[Neonatal bacterial meningitis ]] | |||
*[[Nephrotic syndrome]] | |||
*[[Nonsteriodal anti-inflammatory drugs ]] | |||
*[[Pancreatitis]] | |||
*[[Peritonitis]] | |||
*[[Pituitary cancer]] | |||
*[[Pleuracentesis]] | |||
*[[Pregnancy]] | |||
*[[Pseudohyponatremia]] | |||
*[[Psychogenic polydipsia]] | |||
*[[Psychosis]] | |||
*[[Renal Failure]] | |||
*[[Renal Tubular Acidosis]] | |||
*[[Self-induced water intoxication and schizophrenic disorders syndrome ]] | |||
*[[Subarachnoid hemorrhage]] | |||
*[[Syndrome of inappropriate antidiuretic hormone ]] | |||
*[[Thyrotropin deficiency]] | |||
*[[Tiagabine]] | |||
*[[Tubulointerstitial kidney disease]] | |||
*[[Vomiting]] | |||
*[[Water Intoxication ]] | |||
{{EndMultiCol}} | |||
==References== | ==References== |
Revision as of 03:51, 29 January 2020
Central pontine myelinolysis Microchapters |
Differentiating Central pontine myelinolysis from other Diseases |
---|
Diagnosis |
Treatment |
Case Studies |
Central pontine myelinolysis laboratory findings On the Web |
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Central pontine myelinolysis laboratory findings in the news |
Risk calculators and risk factors for Central pontine myelinolysis laboratory findings |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]
Overview
Laboratory Findings
Laboratory findings consistent with the diagnosis of central pontine myelinolysis include:[1]
- Hypoosmotic hyponatremia
- The rapid correction of hyponatremia is the cause of central pontine myelinolysis.
- The Common causes of hyponatremia include:
- Etiologies of SIAD:
Conditions | |
---|---|
Malignant disorders | Carcinoma: Lung ( small cell carcinoma, mesothelioma), oropharynx, stomach, duodenum, pancreas, ureter, bladder, prostate, endometrium, thymoma
Lymphomas Sarcomas: Ewing's sarcoma Olfactory neuroblastoma |
Pulmonary diseases | Infections: Bacterial pneumonia, viral pneumonia, pulmonary abscess, tuberculosis, aspergillosis
Others: Asthma, cystic fibrosis, respiratory failure, emphysema, COPD, positive-pressure ventilation |
CNS disorders | Infections: Encephalitis, meningitis, brain abscess, RMSF, AIDS, malaria
Vascular and SOP: Subarachnoid hemorrhage, stroke, brain tumors, head trauma Others: Hydrocephalus, cavernous sinus thrombosis, Multiple sclerosis, Guillain–Barré syndrome, Shy–Drager syndrome, delirium tremens, acute intermittent porphyria, chronic psychosis, pituitary stalk section, transsphenoidal adenomectomy |
Other causes | Hereditary: Gain-of-function mutation of V2 receptors
Idiopathic Transient: Exercise, general anesthesia, nausea, pain, stress |
- Causes of acute hyponatremia:
Etiology |
---|
|
( Etiologies that cause hyperacute and acute hyponatremia are applicable to each category interchangeably depending on the onset of symptoms)
- Causes of Hyponatremia based upon Serum Osmolality:
Classification | Serum Osmolality | Etiology |
---|---|---|
Hypertonic or Isotonic Hyponatremia | > 295 mOsm/kg | Hyperglycemia‡, Mannitol, Glycine, Maltose, severe azotemia |
Isotonic Hyponatremia
(Pseudohyponatremia) |
275 – 295 mOsm/kg | Lab/blood draw error, Post TURP (bladder irrigation with osmotic solutions),
intravenous immunoglobulin (IVIg), Hyperlipidemia ( triglyceride, cholesterol ), hyper paraproteinemia (monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma), |
Hypotonic Hyponatremia | < 275 mOsm/kg | Glycerol, Sorbitol, Etiology depends upon volume status (Hypervolemic/ Euvolemic/ Hypovolemic) |
Alcohol, Urea, Ethylen glycol are ineffective osmoles, cause hyperosmolar isotonic serum but not hyponatremia. |
‡ Hyperglycemia causes osmotic diuresis results in a rise in serum sodium concentration, on the other hand it leads to extracellular shift of water due to osmotic gradient which causes relative hyponatremia , depends on which effect is stronger, there would be hypertonicity or hypotonicity[2].
- Causes of Hyponatremia based on volume status [3] :
Volume status | Sodium status | Causes |
---|---|---|
Hypovolemic
Hyponatremia[4] |
|
bicarbonaturia ( renal tubular acidosis, metabolic alkalosis), osmotic diuresis, diuretic use, cerebral salt-wasting syndrome (Stroke ,SAH ,↑ brain natriuretic peptide and ↑ renal sodium loss )
|
Hypervolemic
Hyponatremia |
|
(due to relatively higher water versus salt intake and poor excretion), nephrotic syndrome
|
Euvolemic
Hyponatremia |
|
postoperative nausea, pain, stress, neoplasia (common), trauma, pregnancy) , nephrogenic SIAD (Gain-of-function mutation of v2 receptors)
(caused by a low intake of solutes with relatively high fluid intake)
|
† Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors
- Drugs which cause hyponatremia:
Drug Mechanisms [5] | Drug Classification |
---|---|
Increase ADH secretion | Antidepressants:Tricyclic antidepressants ( Amitryptiline,
Protriptyline, Desipramine),Selective serotonin reuptake inhibitors, Antipsychotic drugs: Phenothiazines (Thioridazine, Trifluoperazine), Antiepileptic drugs: Carbamazepine, Oxcarbazepine, Sodium valproate Anticancer agents: Vinca alkaloids (Vincristine, Vinblastine), Platinum compounds (Cisplatin, Carboplatin) Alkylating agents: Intravenous Cyclophosphamide, Melphalan, Ifosfamide Miscellaneous: Methotrexate, Interferon, Levamisole, Pentostatin, Monoclonal antibodies, MDMA, Nicotine Opiates |
Increase ADH effect | Antiepileptic drugs: Carbamazepine, Lamotrigine
Antidiabetic drugs: Chlorpropamide, Tolbutamide Anticancer agents: Alkylating agents (Intravenous cyclophosphamide) NSAIDS |
Drugs affecting water and sodium homeostasis | Diuretics: Thiazides, Indapamide, Amiloride, Loop diuretics |
Reset omostat ‡ | Antidepressants: Venlafaxine
Antiepileptic drugs: Carbamazepine |
Vasopressin analogues | Desmopressin, oxytocin, terlipressin, vasopressin |
‡ Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors
Causes by Organ System
Causes in Alphabetical Order
References
- ↑ Burgetova A, Vaneckova M, Seidl Z, Dolezal O (2008). "Osmotic demyelination syndrome (central pontine and extrapontine myelinolysis with coagulative necrosis of the putamina and cortical laminar necrosis). A case report and review of the literature". Neuroradiol J. 21 (4): 521–6. doi:10.1177/197140090802100409. PMID 24256958.
- ↑ A. I. Arieff & H. J. Carroll (1972). "Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases". Medicine. 51 (2): 73–94. PMID 5013637. Unknown parameter
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ignored (help) - ↑ Guillaumin, Julien; DiBartola, Stephen P. (2017). "A Quick Reference on Hyponatremia". Veterinary Clinics of North America: Small Animal Practice. 47 (2): 213–217. doi:10.1016/j.cvsm.2016.10.003. ISSN 0195-5616.
- ↑ Rondon-Berrios, Helbert; Agaba, Emmanuel I.; Tzamaloukas, Antonios H. (2014). "Hyponatremia: pathophysiology, classification, manifestations and management". International Urology and Nephrology. 46 (11): 2153–2165. doi:10.1007/s11255-014-0839-2. ISSN 0301-1623.
- ↑ Liamis, George; Milionis, Haralampos; Elisaf, Moses (2008). "A Review of Drug-Induced Hyponatremia". American Journal of Kidney Diseases. 52 (1): 144–153. doi:10.1053/j.ajkd.2008.03.004. ISSN 0272-6386.