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Hypernatremia Differential Diagnosis Algorithm - Diabetes Insipidus Workup

Step #1 - Consider the history
Step #2 - Assess
Hypernatremia Differential ... Diagnosis Algorithm ... Workup Step #1 ... DrEricStrong #Hypernatremia ... #Sodium #nephrology
Causes of Hypernatremia - Differential Diagnosis
Inadequate water intake:
 • Lack of access to water
Extrarenal hypotonic fluid
Causes of Hypernatremia ... Central diabetes insipidus ... Nephrogenic diabetes insipidus ... administration #Hypernatremia ... #nephrology #sodium
Causes of Hypernatremia - Differential Diagnosis Algorithm
Hypernatremia - Excess free water loss, Serum Sodium >145 mmol/L
High
Causes of Hypernatremia ... Hypernatremia ... water loss, Serum Sodium ... kg • Diabetes Insipidus ... Hyperventilation #Hypernatremia
Hypernatremia - Differential Diagnosis Workup Algorithm

1) Check Urine Osmolality:
 > 600 mOsm/kg - Implies extrarenal mechanism
Hypernatremia - ... Extrarenal Hypernatremia ... Ingestion Renal Hypernatremia ... MatthewHoMD #Hypernatremia ... #nephrology #sodium
Hypernatremia Diagnosis and Workup

Step 1 . Repeat the sodium concentration.
Step 2.  Check plasma osmolality.
NORMAL PLASMA
Hypernatremia Diagnosis ... Workup Step 1 ... Repeat the sodium ... mmol/L - true hyponatremia ... renal failure #Hypernatremia
Hyponatremia Differential Diagnosis Algorithm - Utilizing Uric Acid 
ADH promotes Urea/uric acid excretion along with water
Hyponatremia Differential ... Diagnosis Algorithm ... water retention 1) ... Rachel Stern MD #Hyponatremia ... #nephrology #sodium
Hyponatremia Differential Diagnosis Table

 • Step 1: Correct for hyperglycemia. Corrected Na = [(glucose - 100)/
Hyponatremia Differential ... Diagnosis Table ... • Step 1: Correct ... MatthewHoMD #Hyponatremia ... #nephrology #sodium
Etiologies of Hypernatremia - Differential Diagnosis
GI losses / Insensible losses
Sodium Overload
Transcellular Movement of Water
Central Diabetes Insipidus
Etiologies of Hypernatremia ... Insensible losses Sodium ... Central Diabetes Insipidus ... DrEricStrong #Hypernatremia ... #Causes
Hyponatremia - Differential Diagnosis Algorithm
Hypovolemic - Give volume
Hypervolemic (Edematous) - Look for and treat underlying cause
Hyponatremia - Differential ... treat underlying cause ... UnremarkableLab #Hyponatremia ... #diagnosis #nephrology ... #sodium
Physiologic Approach to Hypotonic Hyponatremia
The next time you have a case of hypotonic hyponatremia, give the
Approach to Hypotonic Hyponatremia ... of hypotonic hyponatremia ... +K / serum Na >1 ... Physiologic #Hypotonic #Hyponatremia ... #sodium #nephrology