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Physiologic Approach to Hypotonic Hyponatremia The next time you have a case of hypotonic hyponatremia, give the
• ADH Present (Uosm ... be high or low Uosm ... • ADH Present (Uosm ... differential #diagnosis #table ... #sodium #nephrology
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 ... algorithm #causes #nephrology
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 ... Algorithm #causes #nephrology
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 ... Algorithm #Diagnosis #Nephrology
Hyponatremia Differential Diagnosis Table • Step 1: Correct for hyperglycemia. Corrected Na = [(glucose - 100)/
Differential Diagnosis Table ... BMP • Serum Osm ... • Urine Osm ... Differential #Diagnosis #Table ... #nephrology #sodium
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 ... Challenge #diagnosis #nephrology
Pathophysiology Based Approach to Hyponatremia - Diagnostic Algorithm Not the "classic" Volume based approach. #Hyponatremia #Algorithm #Pathophysiology
#Differential #Nephrology ... #UOsm #Osmolality
Urine chemistry tests for the diagnostic evaluation of a patient with polyuria UOsm <100 mOsm/Kg (H2O diuresis)
with polyuria UOsm ... 2 × (Na + K) = UOsm ... × (Na + K) << UOsm ... differential #diagnosis #nephrology ... #Uosm
Hyponatremia - Diagnostic Evaluation Algorithm Step 1: Consider whether Posm may actually be normal or elevated Step 2:
Consider whether Posm ... Step 2: Check Uosm
Modified Hyponatremia Algorithm Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants Hypotonic Hyponatremia: • ADH ON (UOsm > 100):
Hyponatremia: • ADH ON (UOsm ... wasting • ADH OFF (UOsm ... diagnosis #sodium #nephrology
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