10 results
Hypernatremia Diagnosis and Workup

Step 1 . Repeat the sodium concentration.
Step 2.  Check plasma osmolality.
NORMAL PLASMA
Repeat the sodium ... EUVOLEMIC • SIADH ... • psychogenic polydipsia ... HYPERVOLEMIC • CHF ... #Algorithm #Nephrology
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 ... intake (Primary polydipsia
Volume Based Approach to Hyponatremia
Hypovolemic, Serum uric acid >4
 • Urine Na <20: Extra-renal losses
 •
Based Approach to Hyponatremia ... uric acid <4 • SIADH ... deficiency, Primary polydipsia ... #algorithm #diagnosis ... #sodium #low #nephrology
Hyponatremia Treatment Algorithm

CHF, Cirrhosis - Fluid restriction
SIADH - Fluid restriction
 - Consider salt tablets if etiology
Hyponatremia Treatment ... Algorithm CHF ... Fluid restriction SIADH ... diuresis) 1° polydipsia ... #Treatment #Algorithm
Hyponatremia - Differential Diagnosis Algorithm
Hypovolemic - Give volume
Hypervolemic (Edematous) - Look for and treat underlying cause
Diagnosis Algorithm ... underlying cause (CHF ... - Primary Polydipsia ... , SSRIs) - SIADH ... diagnosis #nephrology #sodium
Primary Polydipsia
Definition: Excessive volitional water intake
Epidemiology:
 • 6-20% of patients with psychiatric disorders - Most commonly
Physiology" • ... Pseudohyponatremia, SIADH ... intoxication Initial Workup ... Osm, Serum Sodium ... , Urine Sodium
Causes of Hyponatremia - Differential Diagnosis Algorithm
Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Causes of Hyponatremia ... Euvolemic; no physiologic ... Reduced GFR, AKI/CRF ... Hypo-osmolar urine ... suppression • Primary polydipsia
Causes of Hyponatremia - Differential Diagnosis Algorithm
Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Causes of Hyponatremia ... Euvolemic; no physiologic ... Reduced GFR, AKI/CRF ... Hypo-osmolar urine ... suppression • Primary polydipsia
Hyponatremia - Differential Algorithm
Isotonic Hyponatremia: Hyperlipidemia, Hyperproteinemia, Recent TURP
Hypotonic Hyponatremia: 
 • Hypovolemia: Diuretics/Nephropathies, Vomiting, Diarrhea,
Algorithm Isotonic ... • Euvolemia: SIADH ... Potomania, Psychogenic polydipsia ... Alcohol MH/CCF ... causes #nephrology #sodium
Hyponatremia - Diagnosis and Treatment
Hyponatremia is usually caused by the inability to excrete water normally.
3 questions to work ... through a physiologic ... Measure urine osmolality ... include vaptans (HF ... management #nephrology #sodium