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Goals and limits for treatment of Hyponatremia Stratified by duration and risk of Osmotic Demyelination Syndrome
for treatment of Hyponatremia ... Demyelination Syndrome ... Acute Hypotonic Hyponatremia ... Demyelination #Syndrome ... #management #hyponatremia
Hypernatremia Diagnosis and Workup

Step 1 . Repeat the sodium concentration.
Step 2.  Check plasma osmolality.
NORMAL PLASMA
Hypernatremia Diagnosis ... Repeat the sodium ... mmol/L - true hyponatremia ... • nephrotic syndrome ... renal failure #Hypernatremia
Modified Hyponatremia Algorithm
Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants
Hypotonic Hyponatremia: 
 • ADH ON (UOsm > 100):
Modified Hyponatremia ... Algorithm Hypertonic Hyponatremia ... irrigants Hypotonic Hyponatremia ... Cirrhosis, Nephrotic syndrome ... Algorithm #diagnosis #sodium
Hyponatremia Correction
1. Indications for Hypertonic Saline: seizure, coma, focal findings
   - typically occurs with
Hyponatremia Correction ... Goal correction ... Overcorrection of Hyponatremia ... Demyelination Syndrome ... #Correction #goal
Hypertonic Saline for Treatment of Hyponatremic Encephalopathy
1) 100 ml bolus of 3% NaCl over 10 min.
for Treatment of Hyponatremic ... achieved with a goal ... hours. 2) Serum sodium ... Increase in sodium ... management #protocol #hyponatremia
Hypernatremia - Differential Diagnosis Workup Algorithm

1) Check Urine Osmolality:
 > 600 mOsm/kg - Implies extrarenal mechanism
Hypernatremia - ... Extrarenal Hypernatremia ... Hypervolemic: Conn syndrome ... , Cushing syndrome ... Algorithm #nephrology #sodium
Volume Based Approach to Hyponatremia
Hypovolemic, Serum uric acid >4
 • Urine Na <20: Extra-renal losses
 •
Based Approach to Hyponatremia ... Cirrhosis, Nephrotic syndrome ... SatyaPatelMD #Volume #Hyponatremia ... algorithm #diagnosis #sodium
Hyponatremia - Differential Diagnosis by Mechanism
Decr Blood Pressure (“Decr Effective Circulating Volume”) 
 - Volume depletion
Hyponatremia - Differential ... - Cirrhosis Syndrome ... DrEricStrong #Hyponatremia ... Table #Causes #Sodium
Physiologic Approach to Hypotonic Hyponatremia
The next time you have a case of hypotonic hyponatremia, give the
Approach to Hypotonic Hyponatremia ... case of hypotonic hyponatremia ... : SIADH, Renal Sodium ... Cirrhosis, Nephrotic syndrome ... diagnosis #table #sodium
Hyponatremia - Differential Diagnosis Algorithm
Hypovolemic - Give volume
Hypervolemic (Edematous) - Look for and treat underlying cause
Hyponatremia - Differential ... cirrhosis, nephrotic syndrome ... UnremarkableLab #Hyponatremia ... diagnosis #nephrology #sodium