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nephrology differential hyponatremia hypernatremia alkalosis causes chloride gitelman hypokalemia hypotonic management metabolic pathophysiology physiologic syndrome table true uricacid urinary volume
True Hyponatremia Differential Algorithm Instead (or in addition) of volume status examination, check urine sodium and serum
Hyponatremia Differential Algorithm ... sodium low, uric ... uric acid low in ... #Differential #Algorithm ... #Diagnosis #Nephrology
Hyponatremia Differential Diagnosis Algorithm - Utilizing Uric Acid ADH promotes Urea/uric acid excretion along with water
Algorithm - Utilizing ... Sodium 4) Serum ... Uric Acid - Low ... #Algorithm #nephrology ... #sodium #low #uricacid
Volume Based Approach to Hyponatremia Hypovolemic, Serum uric acid >4 • Urine Na <20: Extra-renal losses •
uric acid >4 • Urine ... Hypothyroidism, Low ... #Hyponatremia #algorithm ... #diagnosis #sodium ... #low #nephrology
Causes of Hypernatremia - Differential Diagnosis Algorithm Hypernatremia - Excess free water loss, Serum Sodium >145 mmol/L High
- Differential Diagnosis ... water loss, Serum Sodium ... mannitol, glucosuria Low ... Urine Osmolality ... Hypernatremia #Nephrology
Hypernatremia - Differential Diagnosis Workup Algorithm 1) Check Urine Osmolality: > 600 mOsm/kg - Implies extrarenal mechanism
- Differential Diagnosis ... Workup Algorithm ... 1) Check Urine ... • Euvolemic (Low ... #nephrology #sodium
Modified Hyponatremia Algorithm Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants Hypotonic Hyponatremia: • ADH ON (UOsm > 100):
Modified Hyponatremia Algorithm ... Hyperglycemia, Mannitol, Urologic ... Primary polydipsia, Low ... #diagnosis #sodium ... #nephrology
Metabolic Alkalosis - Urinary Chloride Algorithm Cl- responsive metabolic alkalosis • Kidney loss of Cl-
Urinary Chloride Algorithm ... alkalosis • Normal/low ... sodium is typically ... #Algorithm #nephrology ... #differential #diagnosis
Physiologic Approach to Hypotonic Hyponatremia The next time you have a case of hypotonic hyponatremia, give the
normal volume-based algorithm ... Urine Na+K / serum ... can be high or low ... #differential #diagnosis ... #nephrology
Gitelman Syndrome Overview What? • Inherited (AR) hypokalemic salt-losing tubulopathies affecting the thiazide-sensitive sodium chloride cotransporter • Gitelman's syndrome
thiazide-sensitive sodium ... Muscle weakness, dizziness ... alkalosis • Normal or low ... Hypocalciuria (spot urine ... Gitelman #Syndrome #diagnosis
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