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.
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