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    Ang Li
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    Hyponatremia is defined as a serum sodium level below 135 mmol/L. Clinical features depend on severity and can include nausea, vomiting, confusion, seizures or coma. It is important to assess fluid status as hyponatremia can be hypovolaemic, hypervolaemic, or euvolaemic. Treatment depends on severity and fluid status, slowly correcting sodium levels to avoid central pontine myelinolysis. Symptomatic inappropriate ADH secretion (SIADH) can also cause hyponatremia and is diagnosed based on 5 criteria.

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    Hyponatremia is defined as a serum sodium level below 135 mmol/L. Clinical features depend on severity and can include nausea, vomiting, confusion, seizures or coma. It is important to assess fluid status as hyponatremia can be hypovolaemic, hypervolaemic, or euvolaemic. Treatment depends on severity and fluid status, slowly correcting sodium levels to avoid central pontine myelinolysis. Symptomatic inappropriate ADH secretion (SIADH) can also cause hyponatremia and is diagnosed based on 5 criteria.

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    41 views2 pages

    Hyponatremia

    Uploaded by

    Ang Li
    Hyponatremia is defined as a serum sodium level below 135 mmol/L. Clinical features depend on severity and can include nausea, vomiting, confusion, seizures or coma. It is important to assess fluid status as hyponatremia can be hypovolaemic, hypervolaemic, or euvolaemic. Treatment depends on severity and fluid status, slowly correcting sodium levels to avoid central pontine myelinolysis. Symptomatic inappropriate ADH secretion (SIADH) can also cause hyponatremia and is diagnosed based on 5 criteria.

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    of 2

    27/05/2011 Podmedics - Great Medical Podcasts | …

    Chemical Pathology - Hyponatremia

    Hyponatremia
    Hyponatremia = Low Sodium Normal range is 135-145mmol/L. Ergo <135mmol/L is hyponatremia. However,
    pseudonatremia, can make Na appear low, or from blood samples taken from arms with drips in them.

    Clinical features divide into mild, moderate and severe. - Mild 125-130 = disorientation, nausea vomiting. -
    Moderate 115-125 = confused state - Severe <115 may lead to seizures or coma. But overall, the features
    are quite non-specific.

    Very important to talk about fluid status.

    Hypovolaemic
    Hypervolaemic
    Euvolaemic

    Hypovolaemic - subdivide based on urinary sodium. If >20mmol/L then source is fluid loss @ Kidney. Diuretic
    excess. Diuresis (?DM). Mineralecorticoid excess? If <20mmol/L, extrarenal consider vomiting, diahrroea or
    3rd spacing.

    Hypervolaemia - >20mmol/L - Acute or Chronic Renal failure, fluid overload. <20mmol/L Liver Disease, CHF.

    Euvolaemic - stress, hypothyroidism, drugs, inappropriate ADH.

    In hypovolaemic hypovolaemia - history of renal or extra-renal fluid loss. O/E - signs of hypovolaemia.
    Increased Cap refill time, Sinus Tachycardia, Post. hypotension, Dry mucous membranes.

    Hypervolaemic - Organ failure, Signs of overload - Increased JVP, Pul. Oedemoa, Peripheral Oedema,
    Ascites.

    Management - depends on the severity. Correection should occure slowly - or there is a danger of 'central
    pontine myelinolysis'. In mild or moderate - depends on volume status of patient. If hypovolaemic - fluid resus.
    with normal saline - NB monitor urine output etc... In hypervolaemia - restrict fluid intake and give diuretic
    (e.g. furosemide). In euvolaemia - fluid restrict to <1L/day.

    If severe or symptomatic, treat same way, but use extra drugs, dimeclocycline (causes nephrogenic diabetes
    insipidus, use only when Na <125mmol/L), Hypertonic saline (3%)? Use cautiously, and aim to correct
    1mmol/L/hour, use only up to Na=125mmol/L. Do not use this in fluid overload. Consult nephrologist. in which
    case mannitol is available. Conivaptan, Tolvaptan.

    Symptom of Inappropiate ADH (SIADH). ADH secretion in the face of plasma hypotonia and normal/expanded
    plasma volume. Ectopic production or hypothalamic/pituitary access is abnormal.

    5 Criteria:

    Serum sodium <135


    Plasma osmolarity <270
    Urine Osmo >100
    Urine sodium > 20
    Patient must be euvolaemic and no major organ failure or diuretics.

    Malignancies(most commonly non small cell lung ca), pneumonia, TB, drugs (carbamazine, clopropamide
    http://www.podmedics.com/notes/1740 1/2
    27/05/2011 Podmedics - Great Medical Podcasts | …
    and opiates)

    Treatment as for other causes. But treat cause as well.

    http://www.podmedics.com/notes/1740 2/2

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