Hyponatremia

Important Questions
A. Is the lab value real? Repeat any
abnormal lab. Was it drawn above IV
site? What's the glucose? What are
lipids?
B. What's the volume state, based
both on the patient's history and
current exam? What fluids have been
administered?
 Important Questions
C. CNS sx? Are there any recent prior
sodium levels to document the
chronicity of the hyponatremia? The
urgency of correction depends on the
patient's symptoms and the acuteness
of the hyponatremia's onset.
 Differential Diagnosis
The initial differentiation is
between true hyponatremia and
laboratory artifact. True
hyponatremia may be classified
according to the volume status of
the patient: hypovolemic,
euvolemic or hypervolemic.
Hypovolemic hyponatremia may
be further classified by serum and
urine chemistries.
 DIFFERENTIAL DIAGNOSIS of SIADH

1. Malignant neoplasia
a. Carcinoma (bronchogenic,
duodenal, pancreatic, ureteral,
prostatic, bladder)
b. Lymphoma and leukemia
c. Thyoma, mesothelioma, and
Ewing's sarcoma
 DIFFERENTIAL DIAGNOSIS of SIADH

2. CNS disorders
a. Trauma, subarachnoid
hemorrhage, subdural
hematoma
b. Infection (encephalitis,
meningitis,
brain abscess)
c. Tumors
d. Porphyria
e. Stroke
 DIFFERENTIAL DIAGNOSIS of SIADH

3. Pulmonary disorders
a. Tuberculosis
b. Pneumonia
c. Mechanical ventilators with
positive
pressure
d. Lung abscess
 DIFFERENTIAL DIAGNOSIS of SIADH

4. Drugs (including vasopressin,

chlorpropamide, thiazide
diuretics,
oxytocin, vincristine,
haloperidol,
nicotine, phenothiazines,
tricyclic
antidepressants)
 DIFFERENTIAL DIAGNOSIS of SIADH

5. Others

a. "Idiopathic" SIADH
b. Hypothyroidism
 Hyponatremia
HYPONATREMIA CLASSIFIED BASED ON SERUM
OSMOLALITY, VOLUME STATE and URINE SODIUM

Calculated Na Deficit = 0.6 (Wt. in kg) (140 - Na) +

(140) (Volume deficit in L) (mEq)

Corrected Na for LIPID, PROTEIN and GLUCOSE

% serum H2O = 99 - 1.03 (lipids in gm/L) - 0.73

(protein in gm/dl)

corrected Na = measured Na X 93/% serum H2O

change in Na = 0.016 (measured glucose - 100)

corrected Na = 0.016 (measured glucose - 100) +

measured Na