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diagnosis hyponatremia differential hypernatremia low management treatment workup adh cerebral ebv hepatology hepatorenal hrs hypotonic hypovolemia osmolality physiologic potomania raas
Cerebral Salt Wasting vs SIADH - Pathophysiology 1) Neurological event 2) Sodium loss from tubules 3) Naturiesis →
- Pathophysiology ... Neurological event 2) Sodium ... → Increased urine ... #diagnosis #nephrology ... #hyponatremia #comparison
Volume Based Approach to Hyponatremia Hypovolemic, Serum uric acid >4 • Urine Na <20: Extra-renal losses •
uric acid <4 • SIADH ... Cirrhosis, Nephrotic syndrome ... #Hyponatremia #algorithm ... #diagnosis #sodium ... #low #nephrology
Hyponatremia Differential Diagnosis Algorithm - Utilizing Uric Acid ADH promotes Urea/uric acid excretion along with water
ADH promotes Urea ... Osmolarity 2) Urine ... Sodium 4) Serum ... Low Uric Acid → SIADH ... #nephrology #sodium
Physiologic Approach to Hypotonic Hyponatremia The next time you have a case of hypotonic hyponatremia, give the
algorithm Urine ... poor response to volume ... , Renal Sodium loss ... Cirrhosis, Nephrotic syndrome ... #nephrology
Hyponatremia - Differential Diagnosis Algorithm Hypovolemic - Give volume Hypervolemic (Edematous) - Look for and treat underlying cause
Hypovolemic - Give volume ... cirrhosis, nephrotic syndrome ... , SSRIs) - SIADH ... #diagnosis #nephrology ... #sodium
Hypernatremia Diagnosis and Workup Step 1 . Repeat the sodium concentration. Step 2. Check plasma osmolality. NORMAL PLASMA
Repeat the sodium ... EUVOLEMIC • SIADH ... • nephrotic syndrome ... Diagnosis #Workup #Algorithm ... #Nephrology
Management of SIADH Treat underlying cause: • Causes can include pain, primary lung pathology, post-operative phenomenon, medications,
Management of SIADH ... administered • Can cause volume ... promoting passive sodium ... Saline: • If Urine ... #hyponatremia #nephrology
Hypernatremia - Differential Diagnosis Workup Algorithm 1) Check Urine Osmolality: > 600 mOsm/kg - Implies extrarenal mechanism
Diagnosis Workup Algorithm ... 1) Check Urine ... mechanism 2) Volume ... , Cushing syndrome ... #nephrology #sodium
Modified Hyponatremia Algorithm Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants Hypotonic Hyponatremia: • ADH ON (UOsm > 100):
Cirrhosis, Nephrotic syndrome ... OFF (UNa > 30): SIADH ... polydipsia, Low solute ... #diagnosis #sodium ... #nephrology
SIADH Treatment Options 1. Treat underlying cause of SIADH: Pain, Primary lung pathology, Post-operative phenomenon, Medications, Basically
This can cause volume ... Urea powder • Induces ... promoting passive sodium ... 0.9% NS • If Urine ... #hyponatremia #nephrology
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