Hyponatremia resident survival guide: Difference between revisions
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==Management== | ==Management== | ||
{{familytree/start |summary=Hyponatremia}} | {{familytree/start |summary=Hyponatremia}} | ||
{{familytree | | | | | | | | | | | A01 | | | | | | | | | | A01= Serum sodium < 135}} | {{familytree | | | | | | | | | | | A01 | | | | | | | | | | A01= '''Serum sodium < 135'''}} | ||
{{familytree | | | | | | | | | | | |!| | | | | | | | | | | }} | {{familytree | | | | | | | | | | | |!| | | | | | | | | | | }} | ||
{{familytree | | | | | | | | | | | B01 | | | | | | | | | | B01= Plasma osmolality}} | {{familytree | | | | | | | | | | | B01 | | | | | | | | | | B01= '''Plasma osmolality'''}} | ||
{{familytree | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| }} | {{familytree | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| }} | ||
{{familytree | | C01 | | | | | | | | | | | | | | | | | C02 | C01= Hypotonic < 280 | C02= Isotonic/Hypertonic <br> (Pseudohyponatremia) > 280}} | {{familytree | | C01 | | | | | | | | | | | | | | | | | C02 | C01= Hypotonic < 280 | C02= Isotonic/Hypertonic <br> (Pseudohyponatremia) > 280}} | ||
{{familytree | | |!| | | | | | | | | | | | | | | | | | |!| }} | {{familytree | | |!| | | | | | | | | | | | | | | | | | |!| }} | ||
{{familytree | | D01 | | | | | | | | | | | | | | | | | D02 |D01= Assess volume status | D02= Increase in osmotically active <br> compounds; glucose, protein, lipid, <br> mannitol, sorbitol }} | {{familytree | | D01 | | | | | | | | | | | | | | | | | D02 |D01= '''Assess volume status''' | D02= Increase in osmotically active <br> compounds; glucose, protein, lipid, <br> mannitol, sorbitol }} | ||
{{familytree | |,|^|-|-|v|-|-|-|-|-|.| | | | | | | | | |!| }} | {{familytree | |,|^|-|-|v|-|-|-|-|-|.| | | | | | | | | |!| }} | ||
{{familytree | E01 | | E02 | | | | E03 | | | | | | | | E04 | E01= Hypovolemia <br>| E02= Hypervolemia| E03= Euvolemia | E04= Treat etiology }} | {{familytree | E01 | | E02 | | | | E03 | | | | | | | | E04 | E01= '''Hypovolemia''' <br>| E02= '''Hypervolemia'''| E03= '''Euvolemia''' | E04= Treat etiology }} | ||
{{familytree | |!| | | |!| | | | | |!| | | | | | | | | | | }} | {{familytree | |!| | | |!| | | | | |!| | | | | | | | | | | }} | ||
{{familytree | F01 | | F02 | | | | F03 | | | | | | | | | | F01= Spot urine Na < 10, <br> BUN/Creatinine > 20:1, <br> Urine osmolality > 450 | F02= Same as hypovolemia, <br> Spot urine Na < 10, <br> BUN/Creatinine > 20:1, <br> Urine osmolality > 450| F03= Spot urine Na > 20, <br> BUN/Creatinine < 20:1, <br> Urine osmolality > 300 }} | {{familytree | F01 | | F02 | | | | F03 | | | | | | | | | | F01= Spot urine Na < 10, <br> BUN/Creatinine > 20:1, <br> Urine osmolality > 450 | F02= Same as hypovolemia, <br> Spot urine Na < 10, <br> BUN/Creatinine > 20:1, <br> Urine osmolality > 450| F03= Spot urine Na > 20, <br> BUN/Creatinine < 20:1, <br> Urine osmolality > 300 }} | ||
Revision as of 19:39, 20 November 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Definition
Causes
Life Threatening Causes
Conditions that may cause death or permanent disability within the next 24 hours
Common Causes
Management
| Serum sodium < 135 | |||||||||||||||||||||||||||||||||||||||||||||
| Plasma osmolality | |||||||||||||||||||||||||||||||||||||||||||||
| Hypotonic < 280 | Isotonic/Hypertonic (Pseudohyponatremia) > 280 | ||||||||||||||||||||||||||||||||||||||||||||
| Assess volume status | Increase in osmotically active compounds; glucose, protein, lipid, mannitol, sorbitol | ||||||||||||||||||||||||||||||||||||||||||||
| Hypovolemia | Hypervolemia | Euvolemia | Treat etiology | ||||||||||||||||||||||||||||||||||||||||||
| Spot urine Na < 10, BUN/Creatinine > 20:1, Urine osmolality > 450 | Same as hypovolemia, Spot urine Na < 10, BUN/Creatinine > 20:1, Urine osmolality > 450 | Spot urine Na > 20, BUN/Creatinine < 20:1, Urine osmolality > 300 | |||||||||||||||||||||||||||||||||||||||||||
| GI, Renal losses, Dehydration, Diuretics, Adrenal insufficiency, cerebral salt wasting syndrome | Heart failure Cirrhosis Renal failure | Urine osmolality > 300 | Urine osmolality 50-100 | ||||||||||||||||||||||||||||||||||||||||||
| (a) Normal saline; (b) If neurological sign/symptoms 3% hypertonic saline, and furosemide | Treat etiology | SIADH, Hypothyroidism | Compulsive water drinking | ||||||||||||||||||||||||||||||||||||||||||
| (a) Fluid restriction (b) Demeclocycline (if fluid restriction fails) (c) Vaptans; Conivaptan, Tolvaptan for resistant cases | Treat etiology | ||||||||||||||||||||||||||||||||||||||||||||