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Hyponatremia Diagnosis Algorithm UOsm ≥ POsm - Vasopressin-Dependent • UNa < 20 mEq/L - Appropriate (↓ EABV)
Diagnosis Algorithm UOsm ... ≥ POsm - Vasopressin-Dependent ... Cortisol deficiency UOsm ... < POsm - Vasopressin-independent ... differential #algorithm #causes
Polyuria - Differential Diagnosis Algorithm Urine Output > 3L /day Water Diuresis (Urine Osm <100 mOsm/kg) • Primary
Diuresis (Urine Osm ... <100 mOsm/kg) ... 100-200 mOsm/kg ... 300-500 mOsm/kg ... Diagnosis #Algorithm #causes
Hypo-osmolar Hypotonic HypoNatremia Algorithm (Serum Na+ < 135 meq/L, serum Osm < 275 mosm/kg) Assess Volume Status,
135 meq/L, serum Osm ... < 275 mosm/kg) ... Urine Na, Urine Osm
Hyponatremia - Diagnostic Evaluation Algorithm Step 1: Consider whether Posm may actually be normal or elevated Step 2:
Consider whether Posm ... Step 2: Check Uosm ... considered likely, the cause
Physiologic Approach to Hypotonic Hyponatremia The next time you have a case of hypotonic hyponatremia, give the
time you have a case ... • ADH Present (Uosm ... be high or low Uosm ... • ADH Present (Uosm ... differential #diagnosis #table
Hyponatremia - Differential Diagnosis Algorithm Hypovolemic - Give volume Hypervolemic (Edematous) - Look for and treat underlying cause
treat underlying cause ... ) Euvolemic • UOsm ... Toast Diet • UOsm ... Stress, Nausea,
Hyponatremia Differential Diagnosis Table • Step 1: Correct for hyperglycemia. Corrected Na = [(glucose - 100)/
Differential Diagnosis Table ... BMP • Serum Osm ... • Urine Osm ... Differential #Diagnosis #Table
Central vs Nephrogenic Diabetes Insipidus - Desmopressin Challenge Give desmopressin (intranasal, SQ, IV) and monitor UOsm every
IV) and monitor UOsm ... • No Rise in UOsm ... < 45% rise in UOsm ... 15-50% rise in UOsm ... CDI • Rise in UOsm
Causes of Polyuria - Differential Diagnosis Algorithm Polyuria - Urine Output > 3L/day, Increased Urine Volume (>2ml/min) Osmotic
Causes of Polyuria ... Loss - DDAVP -> Uosm ... Insipidus - DDAVP -> Uosm ... Diagnosis #Algorithm #Causes
Causes of Hyponatremia - Differential Diagnosis Algorithm Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Causes of Hyponatremia ... Hypo-osmolar urine - Uosm ... Diagnosis #Algorithm #Causes
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