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diagnosis differential management hypernatremia treatment causes low 3 cancer cerebral comparison di evaluation hypotonic insipidus oncology pathophysiology physiologic saltwasting table
Hypernatremia Diagnosis and Workup Step 1 . Repeat the sodium concentration. Step 2. Check plasma osmolality. NORMAL PLASMA
1 . ... Repeat the sodium ... Step 2. ... HYPERVOLEMIC • CHF ... #Algorithm #Nephrology
Volume Based Approach to Hyponatremia Hypovolemic, Serum uric acid >4 • Urine Na <20: Extra-renal losses •
uric acid <4 • SIADH ... Glucocorticoid deficiency, Primary ... polydipsia Hypervolemic ... #algorithm #diagnosis ... #sodium #low #nephrology
Hyponatremia Differential Diagnosis Algorithm - Utilizing Uric Acid ADH promotes Urea/uric acid excretion along with water
water retention 1) ... Serum Osmolarity 2) ... 3) Urine Sodium ... Low Uric Acid → SIADH ... #nephrology #sodium
Hyponatremia - Differential Diagnosis Algorithm Hypovolemic - Give volume Hypervolemic (Edematous) - Look for and treat underlying cause
underlying cause (CHF ... Solute Intake - Primary ... Polydipsia ... , SSRIs) - SIADH ... #sodium
Modified Hyponatremia Algorithm Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants Hypotonic Hyponatremia: • ADH ON (UOsm > 100):
Algorithm Hypertonic ... OFF (UNa > 30): SIADH ... (UOsm < 100): Primary ... polydipsia, Low ... #sodium #nephrology
Primary Polydipsia Definition: Excessive volitional water intake Epidemiology: • 6-20% of patients with psychiatric disorders - Most commonly
Primary Polydipsia ... occurs in only 2- ... Pseudohyponatremia, SIADH ... , Urine Sodium ... #management #nephrology
Cerebral Salt Wasting vs SIADH - Pathophysiology 1) Neurological event 2) Sodium loss from tubules 3) Naturiesis →
Pathophysiology 1) ... Neurological event 2) ... Sodium loss from ... → Increased urine ... #hyponatremia #
Physiologic Approach to Hypotonic Hyponatremia The next time you have a case of hypotonic hyponatremia, give the
normal volume-based algorithm ... Urine Na+K / serum ... Na >1 is predictive ... polydipsia), Low ... #nephrology
Hyponatremia - Diagnostic Evaluation Algorithm Step 1: Consider whether Posm may actually be normal or elevated Step 2:
Step 1: Consider ... elevated Step 2: ... Check Uosm and/or Urine ... tests Step 5: If SIADH ... #Diagnosis #Workup
Causes of Hyponatremia - Differential Diagnosis Algorithm Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Reduced GFR, AKI/CRF ... Hypo-osmolar urine ... suppression • Primary ... polydipsia • ... #Nephrology #Differential
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