Hyponatremia resident survival guide

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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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Osmotically active compounds,
glucose, protein, lipid,
hypertonic fluid i.e. mannitol, sorbitol
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypovolemia
 
Hypervolemia
 
 
 
Euvolemia
 
 
 
 
 
 
 
Treat the cause
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 the etiology
 
SIADH, Hypothyroidism
 
Compulsive water drinking
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
(a) Fluid restriction
(b) Demeclocycline (if
fluid restriction fails)
(c) Vaptans; Conivaptan,
Tolvaptan for resistant cases
 
Treat the cause
 
 
 
 
 
 
 

Do's

Don'ts

References


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