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Hyponatraemia - Coggle Diagram
Hyponatraemia
Aetiology
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- Injudficious IV fluid - esp in surgical
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- CArdiac, liver, renal failure - ass with hypervolaemic hyponatraemia
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Assessment
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- Med list
- Fluid intake and foot
- Neurological symptoms
- Acute or chronic
- Co-morbidities
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Urea and glucose
Plasma and Urine osmolality
Urinary Na+
TFTs
+/- assessment of cortisol
Assessment of underlying causes - chest imaging ? tumours?
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Pathophysiology
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- Increased serum osmolality
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- Hyposomolality in hypotonic hypona
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Osmotic Demyelination
- several days after treatment
- demyelination of pontine and extrapontine (thalamus, basal nuclei, cerebellum neurons
- flaccid quadriplegia, pseudopulbar palsy, seizure, coma, death
- At risk grousp : women, elderly, children, malnourished, alcholoics, CNS disease, hypoxaemia, low BMI esp <60kg
Avoiding
- Be aware of population at risk (Na <120 of >48 hrs duration)
- Be aware of high risk groups
- High risk of ODS - mitints of Na+ rise 8mmol
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SIADH
Hyponatraemi <135
Plasma hypo-osmolality <275
Urine osmolality >100
Clinicaly euvolaemia
Increased urinary Na >40 with normal salt and water intake
Absence fof other potential causes of euvolaemic hyponatraemia
Brain Volume Adaptation
Immediate effect of hypotonic effect - Water gain - swelling
Rapid adaptation - loss of Na, K, Cl - loss of organic osmolites
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