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Hyponatremia in Hypothyroidism - Pathophysiology

- BWH Medicine Chiefs @BrighamChiefs

#Hyponatremia #Hypothyroidism #Pathophysiology #endocrinology
Hyponatremia in ... Hypothyroidism - ... BrighamChiefs #Hyponatremia ... #Hypothyroidism
Hypernatremia Diagnosis and Workup

Step 1 . Repeat the sodium concentration.
Step 2.  Check plasma osmolality.
NORMAL PLASMA
Hypernatremia Diagnosis ... mmol/L - true hyponatremia ... • SIADH • hypothyroidism ... 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 ... Medications (diuretics), Hypothyroidism ... SatyaPatelMD #Hyponatremia
Hyponatremia - Differential Diagnosis Algorithm
ADH Independent:
 • Tea and Toast Syndrome, Beer Potomania - Low solute
Hyponatremia - Differential ... • Euvolemic - Hypothyroidism ... thecurbsiders #Hyponatremia
Volume Based Approach to Hyponatremia
Hypovolemic, Serum uric acid >4
 • Urine Na <20: Extra-renal losses
 •
Based Approach to Hyponatremia ... acid <4 • SIADH, Hypothyroidism ... SatyaPatelMD #Volume #Hyponatremia
Causes of Hyponatremia - Differential Diagnosis Algorithm
Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Causes of Hyponatremia ... Hormonal changes • Hypothyroidism ... osmole intake #Hyponatremia
Causes of Hyponatremia - Differential Diagnosis Algorithm
Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Causes of Hyponatremia ... Hormonal changes • Hypothyroidism ... osmole intake #Hyponatremia
Hyponatremia - Differential Diagnosis Algorithm
Hypovolemic - Give volume
Hypervolemic (Edematous) - Look for and treat underlying cause
Hyponatremia - Differential ... CKD, Thiazides, Hypothyroidism ... UnremarkableLab #Hyponatremia
Hyponatremia - Differential Algorithm
Isotonic Hyponatremia: Hyperlipidemia, Hyperproteinemia, Recent TURP
Hypotonic Hyponatremia: 
 • Hypovolemia: Diuretics/Nephropathies, Vomiting, Diarrhea,
Hyponatremia - Differential ... Algorithm Isotonic Hyponatremia ... TURP Hypotonic Hyponatremia ... Renal Failure, Hypothyroidism ... Hypertonic Hyponatremia
Hyponatremia - Differential Diagnosis by Mechanism
Decr Blood Pressure (“Decr Effective Circulating Volume”) 
 - Volume depletion
Hyponatremia - Differential ... Endocrinopathies - Hypothyroidism ... DrEricStrong #Hyponatremia