Causes of Hyponatremia - Differential Diagnosis Algorithm
Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to ADH
• Pain/Post-op
• Neurologic trauma
• Drugs
• Pulmonary pathology
• Malignancy
True hypovolemia
• Bleeding
• GI losses
• Renal losses (especially thiazide diuretics)
With edema
• Congestive heart failure
• Cirrhosis
• Nephrotic syndrome
• Reduced GFR, AKI/CRF
Hormonal changes
• Hypothyroidism
• Adrenal insufficiency
• Pregnancy
Hypo-osmolar urine - Uosm < 100 mmol/kg - ADH suppression
• Primary polydipsia
• Insufficient osmole intake
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