Hyponatremia resident survival guide: Difference between revisions

Revision as of 19:55, 20 November 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Conditions that may cause death or permanent disability within the next 24 hours

Serum sodium < 135 mEq/L

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

Fluid restriction,
Diuretics,
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

@@ Line 25: / Line 25: @@
 {{familytree | G01 | | G02 | | G03 | | G04 | | | | | | | | G01= GI, renal losses, <br> dehydration, diuretics, <br> adrenal insufficiency, <br> cerebral salt wasting <br> syndrome   | G02= heart failure <br> cirrhosis <br> renal failure | G03= Urine osmolality > 300 | G04= Urine osmolality 50-100}}
 {{familytree | |!| | | |!| | | |!| | | |!| | | | | | | | | }}
-{{familytree | H01 | | H02 | | H03 | | H04 | | | | | | | | H01= (a) Normal saline; <br> (b) If neurological <br> sign/symptoms 3% <br> hypertonic saline, <br> and furosemide| H02=  Fluid restriction <br> Diuretics  <br> Treat etiology | H03= SIADH, Hypothyroidism | H04= Compulsive water drinking }}
+{{familytree | H01 | | H02 | | H03 | | H04 | | | | | | | | H01= (a) Normal saline; <br> (b) If neurological <br> sign/symptoms 3% <br> hypertonic saline, <br> and furosemide| H02=  Fluid restriction, <br> Diuretics,  <br> Treat etiology | H03= SIADH, Hypothyroidism | H04= Compulsive water drinking }}
 {{familytree | | | | | | | | | |!| | | |!| | | | | | | | | }}
 {{familytree | | | | | | | | | I01 | | I02 | | | | | | | | I01= (a) Fluid restriction <br> (b) Demeclocycline (if  <br> fluid restriction fails) <br> (c) Vaptans; Conivaptan, <br> Tolvaptan for resistant cases  | I02= Treat etiology}}