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Hyponatremia <135 mEq/L - Coggle Diagram

- - - - High >295
        
        Hypertonic hyponatremia (osmotic substance that moves water out of cells --> dilutes the sodium)
        
        Mannitol
        
        Glycerol
        
        Hyperglycemia
        
        Serum glucose raises serum tonicity which pulls the water ou of cells --> increases extracellular water space
      - Normal 280-295
        
        Pseudohyponatremia = laboratory artifact
        Hyperlipidemia or hyperproteinemia lowers the serume sodium concentration when measured with certain analyzers
        
        Obstructive jaundice --> increased cholesterol
        
        Plasma cell dyscrasia --> increased protein
  - - - Hypovolemic
        
        Urine Na+
        (Determine whether GFR is impaired)
        
        Low <25
        
        Hypovolemia / extrarenal salt loss
        
        Diarrhea/vomiting
        
        High >40
        
        Renal salt loss
        
        Excessive diuretic use
        
        Low aldosterone in primary adrenal insufficiency
        
        Exogenous glucocorticoids for prolonged periods of time
        
        Critical illness
        Chronic adrenal insufficiency
        
        Diagnosis
        
        Cortisol concentration - serum and morning serum
        
        ACTH stimulation
        
        ATN
        
        Cerebral salt wasting
        
        Head injury - subarachnoid hemorrhage
        
        25-40
      - Euvolemic
        
        High urine sodium + osmolality
        
        Hypothyroidism
        
        SIADH
        
        Treatment:
        Vasopressin antagonists = vaptans
        
        Low sodium + osmolality
        
        Postoperative/Malnutrition
        
        Psychogenic polydipsia
      - Hypervolemic
        
        Nephrotic syndrome =
        Electrolytes not properly filtered
        
        Increased plasma/extracellular volumes (although body perceives as volume depletion due to decreased arterial blood volume) --> ADH release
        
        Liver disease
        
        Systemic vasodilation (nitric oxide) causes decreased SVR
        
        Treatment:
        
        Withdraw beta blockers, diuretics
        
        Severe symptomatic hyponatremia
        
        Albumin infusion 1 g/kg body infused daily
        
        Hypertonic saline
        
        CHF
        
        Low cardiac output decreases pressure on baroreceptors --> limit sodium and water excretion to help return perfusion pressure --> ADH
        
        Treatment:
        
        Fluid restriction
        
        ACE inhibitors - improve cardiac function
        
        Vasopressin (ADH) antagonists
        
        Patient is edematous = peripheral or pulmonary edema, ascites