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Physiologic Approach to Hypotonic Hyponatremia The next time you have a case of hypotonic hyponatremia, give the
time you have a case ... normal volume-based algorithm ... Urine Na+K / serum ... restriction alone in SIADH ... Present (Uosm ≥100): SIADH
Causes of Hyponatremia - Differential Diagnosis Algorithm Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Causes of Hyponatremia ... Differential Diagnosis Algorithm ... • Reduced GFR, AKI ... Hypo-osmolar urine ... #Causes
Causes of Hyponatremia - Differential Diagnosis Algorithm Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Causes of Hyponatremia ... Differential Diagnosis Algorithm ... • Reduced GFR, AKI ... Hypo-osmolar urine ... #Causes
Hyponatremia Differential Diagnosis Algorithm - Utilizing Uric Acid ADH promotes Urea/uric acid excretion along with water
Hyponatremia Differential ... Diagnosis Algorithm ... Utilizing Uric Acid ADH ... Osmolarity 2) Urine ... Low Uric Acid → SIADH
Hyponatremia - Differential Diagnosis Algorithm ADH Independent: • Tea and Toast Syndrome, Beer Potomania - Low solute
Hyponatremia - Differential ... Diagnosis Algorithm ... ADH Independent ... insufficiency, SIADH ... #causes #nephrology
Hyponatremia - Differential Diagnosis Algorithm Hypovolemic - Give volume Hypervolemic (Edematous) - Look for and treat underlying cause
Hyponatremia - Differential ... Diagnosis Algorithm ... treat underlying cause ... • UOsm > 300 - ADH ... , SSRIs) - SIADH
Modified Hyponatremia Algorithm Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants Hypotonic Hyponatremia: • ADH ON (UOsm > 100):
Algorithm Hypertonic ... : • ADH ON (UOsm ... OFF (UNa > 30): SIADH ... salt wasting • ADH ... #Algorithm #diagnosis
Cerebral Salt Wasting vs SIADH - Pathophysiology 1) Neurological event 2) Sodium loss from tubules 3) Naturiesis →
Salt Wasting vs SIADH ... Hypovolaemia → ADH ... → Increased urine ... #SaltWasting #SIADH ... diagnosis #nephrology #hyponatremia
Hyponatremia - Diagnostic Evaluation Algorithm Step 1: Consider whether Posm may actually be normal or elevated Step 2:
Hyponatremia - Diagnostic ... Evaluation Algorithm ... Check Uosm and/or Urine ... tests Step 5: If SIADH ... considered likely, the cause
Hyponatremia Treatment Algorithm CHF, Cirrhosis - Fluid restriction SIADH - Fluid restriction - Consider salt tablets if etiology
Hyponatremia Treatment ... Algorithm CHF ... Fluid restriction SIADH ... status turns off ADH ... #Treatment #Algorithm
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