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nephrology diagnosis differential management causes low cardiology heartfailure hypernatremia table workup cerebral clinical comparison congestive criticalcare diuresis ebv foamed hyperkalemia
Cerebral Salt Wasting vs SIADH - Pathophysiology 1) Neurological event 2) Sodium loss from tubules 3) Naturiesis →
Neurological event 2) Sodium ... ) Naturiesis → diuresis ... → ADH → water reabsorption ... → Increased urine ... diagnosis #nephrology #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 ... restriction alone in SIADH ... , Renal Sodium loss ... , Hypervolemia with
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
Modified Hyponatremia Algorithm Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants Hypotonic Hyponatremia: • ADH ON (UOsm > 100):
Algorithm Hypertonic ... ON (UNa < 30): Hypovolemia ... OFF (UNa > 30): SIADH ... , Medications (diuretics ... #sodium #nephrology
Hyponatremia Differential Diagnosis Algorithm - Utilizing Uric Acid ADH promotes Urea/uric acid excretion along with water
Hyponatremia Differential ... Diagnosis Algorithm ... Utilizing Uric Acid ADH ... Sodium 4) Serum ... Low Uric Acid → SIADH
Hyponatremia - Differential Diagnosis Algorithm Hypovolemic - Give volume Hypervolemic (Edematous) - Look for and treat underlying cause
Diagnosis Algorithm ... Hypovolemic - Give ... underlying cause (CHF ... , 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 ... HYPOVOLEMIC • ... volume loss - diuretics ... EUVOLEMIC • SIADH ... HYPERVOLEMIC • CHF
Causes of Hyponatremia - Differential Diagnosis Algorithm Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Causes of Hyponatremia ... Malignancy True hypovolemia ... especially thiazide diuretics ... Reduced GFR, AKI/CRF ... Hypo-osmolar urine
Causes of Hyponatremia - Differential Diagnosis Algorithm Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Causes of Hyponatremia ... Malignancy True hypovolemia ... especially thiazide diuretics ... Reduced GFR, AKI/CRF ... Hypo-osmolar urine
Hyponatremia - Differential Algorithm Isotonic Hyponatremia: Hyperlipidemia, Hyperproteinemia, Recent TURP Hypotonic Hyponatremia: • Hypovolemia: Diuretics/Nephropathies, Vomiting, Diarrhea,
Algorithm Isotonic ... : Diuretics/Nephropathies ... • Euvolemia: SIADH ... Alcohol MH/CCF ... causes #nephrology #sodium
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