Hyponatremia - Diagnosis and Treatment Hyponatremia is usually caused by the inability to excrete water normally. In the vast majority of cases, ADH (appropriately or inappropriately secreted) is the culprit. Always start with a good history and exam, paying particular attention to volume status. Then, ask 3 questions to work through a physiologic approach to the differential! 1) Is it hypotonic? Calculate serum osmolality! 2) Is ADH elevated? Measure urine osmolality! 3) Is it appropriate? Assess volume status (EABV)! Treatment: Treatment of hyponatremia is a complex issue which varies based on chronicity and severity. Generally, treat the underlying cause and avoid rapid correction (max rate of correction 8 mEq/L/day) Rapid correction of chronic hyponatremia puts patients at risk for osmotic demyelination syndrome. 3% saline can be administered (through a peripheral IV!) in 100 mL boluses over 10 minutes up to 3x in the setting of symptomatic (seizures. obtundation. coma. respiratory arrest) hyponatremia. Other options for severe/refractory hypoNa include vaptans (HF/liver disease) and augmentation with DDAVP may be required. Dr. Meredith Greer @EmmGeezee #Hyponatremia #Differential #Diagnosis #Treatment #management #nephrology #sodium
