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109
S. Faubel and J. Topf6 Hyponatremia: The Pathophysiology
6
Hyponatremia:6The Pathophysiology
The Empire Strikes Back
110
The Fluid, Electrolyte and Acid-Base Companion
Introduction
Hyponatremia is usually associated with hypoos-molality.
Hyponatremia is a plasma sodium concentration less than 135 mEq/L. Sincesodium is the major contributor to plasma osmolality, a low sodium concentra-tion is usually associated with hypoosmolality.
Hyponatremia is important because it can indicate a low plasma osmolal-ity.
Hyponatremia not associated with a low plasma osmolality is not worri-some and is not treated.The relationship between hyponatremia and hypoosmolality is similar tothe relationship between fever and infection. In general, fever is not a prob-lem in and of itself, but is an alert to the possible presence of infection.Likewise, hyponatremia in and of itself is not worrisome, but it is an alert tothe possible presence of hypoosmolality. Hyponatremia associated with hy-poosmolality is a concern because of the neurologic consequences of osmoticwater shifts in the brain. (See Chapter 5,
Osmoregulation.
)
HYPOOSMOLALITY
osmolality < 285 mmol/L
HYPONATREMIA
sodium < 135 mEq/L
Hyponatremia is a plasma sodium less than ______ mEq/L.Hyponatremia is only a problem if it associated with ________plasma osmolality.Hyponatremia associated with ________ or elevated plasma os-molality is not dangerous.135decreasednormal
ALWAYS
EQUALSUSUALLY
EQUALS
111
S. Faubel and J. Topf6 Hyponatremia: The Pathophysiology
True hyponatremia is hyponatremia associated with a low plasma osmo-lality. Pseudohyponatremia
is hyponatremia associated with a normal orhigh plasma osmolality. The two types of pseudohyponatremia are:•
Hyponatremia with a normal plasma osmolality
is due to a labartifact from hyperlipidemia or hyperproteinemia.•
Hyponatremia with a high plasma osmolality
is due to an in-creased concentration of osmotically active particles, such as glu-cose or mannitol.When hyponatremia is discovered, the presence of true hyponatremiashould be assessed by measuring plasma osmolality. The causes of pseudo-hyponatremia are discussed in detail on the following pages.
Introduction
Pseudohyponatremia
Hyponatremia not asso-ciated with hypoosmolality is pseudohyponatremia.
As with all abnormal labs, when hyponatremia is found, the level should be repeated to ruleout a lab or blood-drawing error. When repeating the sodium level, the blood should bedrawn through the skin (not from an IV line) and from a vein that does not have IV fluidsflowing through it. Blood diluted by IV fluid can cause erroneous sodium measurements.
_________ is the major osmotically active solute in the____________ compartment.True hyponatremia is associated with __________, while_________ is associated with a normal or high plasmaosmolality.Sodiumextracellularhypoosmolalitypseudohyponatremia
high osmolality
True hyponatremia
low osmolality
Pseudohyponatremia
normal osmolality
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