![]() Other possible causes include glucocorticoid deficiency (secondary adrenal insufficiency), diuretic treatment (with information about treatment either lacking or concealed by the patient), and severe hypothyroidism. In patients with normal ECF water content, hyponatremia is most frequently caused by SIADH. Estimate water content in the ECF based on clinical data.Ī) In patients with increased ECF water content (edema, effusions to body cavities), hyponatremia may be caused by heart failure, cirrhosis, or nephrotic syndrome.ī) In patients with decreased ECF water content (features of dehydration and hypovolemia), hyponatremia may be caused by loss of water and sodium via the GI tract, skin, or due to a shift of water to the “third space” or by diuretic treatment (with information about treatment either lacking or concealed by the patient).Ģ) Patients with U Na>30 mmol/L should be assessed for kidney disease or diuretic treatment (or both).Ī) In patients who have no kidney disease and do not use diuretics, estimate ECF water content on the basis of clinical data. Hyponatremia is diagnosed in patients with serum 100 mmol/kg H 2O, measure U Na:ġ) In patients with U Na ≤30 mmol/L, hyponatremia may be caused by low effective intravascular volume. Note: These manifestations are nonspecific and may have other causes.Īcute hyponatremia is suspected in the following clinical situations (in patients with undocumented duration of hyponatremia): postoperative period, polydipsia, after or during strenuous exercise, recently started treatment with thiazide diuretics, preparation to colonoscopy, treatment with IV cyclophosphamide, amphetamine use, recently started treatment with ADH analogues.Ĭlinical features suggestive of dehydration and hypovolemia include dry mucous membranes, reduced skin turgor, orthostatic or constant hypotension, tachycardia, and decreased urine output.ĭiagnostic algorithm in hyponatremia: Figure 5.2-1. They may be:ġ) Moderate, including nausea (without vomiting), confusion, and headache.Ģ) Severe, including vomiting, somnolence, seizures, and coma (Glasgow coma score ≤8). Neurologic manifestations of hyponatremia depend on the severity and rate of plasma sodium level decrease and the resulting changes in plasma osmolality. In the majority of patients with slowly developing mild to moderate hyponatremia, no serious central nervous system ( CNS) symptoms are seen, but impaired concentration, impaired cognitive functions, and dizziness may occur. Plasma osmolality is normal.Ĭlinical manifestations depend on the severity and rate of plasma sodium level decrease, effective plasma osmolality, and direction and magnitude of blood volume changes. Pseudohyponatremia is a falsely low serum caused by high plasma lipid or paraprotein levels. Less frequent causes include IV infusions of mannitol administration of high doses of hyperosmolal contrast media or leakage of isotonic mannitol, sorbitol, or glycine to blood during transurethral prostate resection. Hyponatremia is defined as a serum 10 mmol/L). Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Verbalis JG, Goldsmith SR, Greenberg A, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Spasovski G, Vanholder R, Allolio B, et al Hyponatraemia Guideline Development Group. Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Hew-Butler T, Rosner MH, Fowkes-Godek S, et al.
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