Hyponatremia physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].


OR
Hyponatremia by itself has the signs of CNS function impairment and the other signs which can be detected in the physical exam are caused by the etiologies of hyponatremia. Depending on the severity of hyponatremia, signs vary from subtle cognitive impairment to brain death. Patients who present with hyponatremia, depending on the underlying causes, may present with different signs in clinical evaluation.


Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
==Physical Examination ==
 
* [[Nausea]] and [[malaise]] are the earliest signs of hyponatremia.
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
==Physical Examination==
* Nausea and malaise are the earliest signs of hyponatremia.
{| class="wikitable"
{| class="wikitable"
!<big>Classification</big>
!<big>Classification</big>
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|'''Hypervolemic'''
|'''Hypervolemic'''
'''hyponatremia'''
'''hyponatremia'''
|Peripheral edema, ascites, pulmonary edema, raised JVP,clinical signs of underlying causes
|[[Peripheral edema]], [[ascites]], [[pulmonary edema]], raised [[JVP]],clinical signs of underlying causes
|-
|-
|'''Euvolemic hyponatremia'''
|'''Euvolemic hyponatremia'''
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|-
|-
|'''Hypovolemic hyponatremia'''
|'''Hypovolemic hyponatremia'''
|Dry mucous membrane, decreased skin turgor, hypotension (orthostatic), tachycardia
|Dry mucous membrane, decreased skin turgor, [[Orthostatic hypotension|hypotension (orthostatic)]], [[tachycardia]]
|}
|}
Determination of volume status i.e. dehydration, edema, ascites should be carried out.[29] Patients with clinical signs of volume depletion (e.g. orthostatic decreases in blood pressure and increases in pulse rate, dry mucus membranes, decreased skin turgor) should be considered hypovolemic. When available, direct hemodynamic measurements can provide corroboration of the clinical impression.
to see the causes of hyponatremia, click [[Hyponatremia causes#Causes|here]].
* Look for signs of hypothyroidism
* Look for signs of Endocrine disease like [[adrenal insufficiency]], [[hypothyroidism]], hypopituitarism
* Look for signs of adrenal insufficiency
* Clinical signs of CHF, RF,
* Detailed examination to detect any CNS or lung lesion.
* Detailed examination to detect any lesions in the body to rule out any malignacies
* Look for signs of infectious disease
* Look for signs of drus use
* Look for any signs of CNS involvement
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with hyponatremia may appear with wide range of presentations from no discomfort to severe distress
*Patients with hyponatremia may appear with wide range of presentations from no discomfort to severe distress.


===Vital Signs===
===Vital Signs===
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===Skin===
===Skin===
* Skin examination of patients with hyponatremia varies depend on the underlying causes like hypothyroidism, CHF, adrenal insufficeincy
* Skin examination of patients with hyponatremia varies depend on the underlying causes like hypothyroidism, CHF, adrenal insufficiency
OR
 
*[[Cyanosis]]  
*[[Cyanosis]]  
*[[Jaundice]]
*[[Jaundice]]
* [[Pallor]]
* [[Pallor]]
* Bruises
* Bruises
<gallery widths="150px">
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with hyponatremia varies depending on the causes: tumor, thyriod diseases
* HEENT examination of patients with hyponatremia varies depending on the causes: tumor, thyroid diseases


* Abnormalities of the head/hair may include hair loss, brittle hair
* Abnormalities of the head/hair may include hair loss, brittle hair
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* Icteric sclera  
* Icteric sclera  
* [[Nystagmus]]  
* [[Nystagmus]]  
* Extra-ocular movements may be abnormal in case of tumor associated hyponatremia
* Extra-ocular movements may be abnormal in case of tumor-associated hyponatremia
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of brain edema
*Ophthalmoscopic exam may be abnormal with findings of brain edema
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* Muscle rigidity
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* Proximal/distal muscle weakness unilaterally/bilaterally
* In case of brain edema or heniation involvement of cranial nerves may be seen
* In case of brain edema or herniation involvement of cranial nerves may be seen
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Positive straight leg raise test
*Abnormal gait ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait may be present
*Abnormal gait ataxic (cerebellar) gait/steppage gait/waddling gait / choreiform gait / Parkinsonian gait / sensory gait may be present
*Positive/negative Trendelenburg sign
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)

Latest revision as of 20:38, 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

Hyponatremia by itself has the signs of CNS function impairment and the other signs which can be detected in the physical exam are caused by the etiologies of hyponatremia. Depending on the severity of hyponatremia, signs vary from subtle cognitive impairment to brain death. Patients who present with hyponatremia, depending on the underlying causes, may present with different signs in clinical evaluation.

Physical Examination

Classification Clinical signs
Hypervolemic

hyponatremia

Peripheral edema, ascites, pulmonary edema, raised JVP,clinical signs of underlying causes
Euvolemic hyponatremia Clinical signs of underlying causes
Hypovolemic hyponatremia Dry mucous membrane, decreased skin turgor, hypotension (orthostatic), tachycardia

to see the causes of hyponatremia, click here.

  • Look for signs of Endocrine disease like adrenal insufficiency, hypothyroidism, hypopituitarism
  • Clinical signs of CHF, RF,
  • Detailed examination to detect any lesions in the body to rule out any malignacies
  • Look for signs of infectious disease
  • Look for signs of drus use
  • Look for any signs of CNS involvement

Appearance of the Patient

  • Patients with hyponatremia may appear with wide range of presentations from no discomfort to severe distress.

Vital Signs

  • High-grade / low-grade fever
  • Hypothermia / hyperthermia may be present
  • Tachycardia with regular pulse or (ir)regularly irregular pulse
  • Bradycardia with regular pulse or (ir)regularly irregular pulse
  • Tachypnea / bradypnea
  • Kussmal respirations may be present
  • Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse may be present
  • High/low blood pressure with normal pulse pressure / wide pulse pressure / narrow pulse pressure may be present

Skin

  • Skin examination of patients with hyponatremia varies depend on the underlying causes like hypothyroidism, CHF, adrenal insufficiency

HEENT

  • HEENT examination of patients with hyponatremia varies depending on the causes: tumor, thyroid diseases
  • Abnormalities of the head/hair may include hair loss, brittle hair
  • Evidence of trauma
  • Icteric sclera
  • Nystagmus
  • Extra-ocular movements may be abnormal in case of tumor-associated hyponatremia
  • Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
  • Ophthalmoscopic exam may be abnormal with findings of brain edema
  • Hearing acuity may be reduced
  • Weber test may be abnormal
  • Rinne test may be positive
  • Facial tenderness
  • Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae

Neck

  • Neck examination of patients with hyponatremia may lead to other causes like tumors

Lungs

  • Pulmonary examination of patients with severe hyponatremia
  • Asymmetric chest expansion / Decreased chest expansion
  • Lungs can be hypporesonant/hyperresonant
  • Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
  • Rhonchi
  • Vesicular breath sounds / Distant breath sounds
  • Expiratory/inspiratory wheezing with normal / delayed expiratory phase
  • Wheezing may be present
  • Egophony present may be present
  • Bronchophony present may be present
  • Reduced tactile fremitus may be present

Heart

  • Cardiovascular examination of patients with hyponatremia

Abdomen

Back

  • Point tenderness over vertebrae
  • Sacral edema
  • Costovertebral angle tenderness bilaterally/unilaterally
  • Buffalo hump

Genitourinary

  • A pelvic/adnexal mass may be palpated
  • Inflamed mucosa

Neuromuscular

  • Patient can be oriented to persons, place, and time
  • Altered mental status
  • Glasgow coma scale has to be checked
  • Hyperreflexia / hyporeflexia / areflexia
  • Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
  • Muscle rigidity
  • Proximal/distal muscle weakness unilaterally/bilaterally
  • In case of brain edema or herniation involvement of cranial nerves may be seen
  • Unilateral/bilateral upper/lower extremity weakness
  • Unilateral/bilateral sensory loss in the upper/lower extremity
  • Positive straight leg raise test
  • Abnormal gait ataxic (cerebellar) gait/steppage gait/waddling gait / choreiform gait / Parkinsonian gait / sensory gait may be present
  • Positive/negative Trendelenburg sign
  • Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
  • Normal finger-to-nose test / Dysmetria my be present

Extremities

  • Clubbing
  • Cyanosis
  • Pitting/non-pitting edema of the upper/lower extremities
  • Muscle atrophy
  • Fasciculations in the upper/lower extremity

References

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