Hyponatremia

Hyponatremia: Sx = Neuro changes

  • Must look for underlying cause:
    • Fluid overload: CHF, Cirrhosis, acute/chronic kidney failure
    • Hypovolemia: Loss of sodium and water: Dehydration, GI/kidney fluid loss, hypoaldosterone
    • Euvolemic: SIADH
      • SIADH: Restrict fluids.
    • ***Labs to order when evaluating Hyponatremia:
      • Urine osmolality, Serum osmolality, Urinary sodium concentration
      • These are the three essential laboratory tests in the evaluation of patients with hyponatremia that, together with the history and the physical examination, help to establish the primary underlying etiologic mechanism. (In general, the etiology of the hyponatremia directs its management.)
  • Pseudohyponatramia (from hyperglycemia): Correct for BG.
    • http://www.mdcalc.com/sodium-correction-for-hyperglycemia/
  • Tx: Fluid restriction, Lasix, oral salt supplements
    1. SIADH: Demeclocycline or Vaptans.
    2. AMS + hypovolemia: NS IV fluid (moderately hypertonic)
    3. Acute symptoms (stupor/AMS/seizures/unresponsive/coma): 3% saline (very hypertonic)
      1. Give 100cc of hypertonic (3%) saline over 10 minutes and an additional 100cc over 50 minutes and 100cc over 1 hour. Fluid restriction and supportive therapy. Follow BMP q3hr. Consult Nephrology. Then start NS (0.9%) IVF @ 100cc/hr. Likely will also need to be emergently intubated.
Source: http://www.uptodate.com/contents/image?imageKey=NEPH%2F101823&topicKey=NEPH%2F2354&rank=2%7E2&source=see_link&search=beer+potomania&utdPopup=true

Source: http://www.uptodate.com/contents/image?imageKey=NEPH%2F101823&topicKey=NEPH%2F2354&rank=2%7E2&source=see_link&search=beer+potomania&utdPopup=true

Leave a Reply

Your email address will not be published.