Hyponatraemia

Exclude pseudoNa (glycaemia, lipid, protein)

Vol. Urine Na+:

Euvolaemia

Vol.

<20

>20

<20

>20

<20

>20

Extra renal loss

GI !eat "rd space

Renal loss

#syc$ogenic !ater load

I%&' Glucocorticoid de(iciency 'ypot$yroidism

))* )irr$osis Nep$rotic syndrome

%+* )+*

DGIM Last updated March 2005

HYPONATREM A Is #lasma osmolality lo!No .es Is E)* ,olume contracted'yperglycemia /a0 error

Yes !primary Na loss" 1rine Na $ig$ lo!

No !primary H#O $ain" E((ecti,e arterial ,olume lo! normal

1rine 4 $ig$ lo!

GI2 loss 3in loss

/o! al0umin )ardiac (ailure

I%&' #rimary polydypsia

&iuretics 2u0ulopat$ies

/o! aldosterone /o! renal response to aldosterone

DGIM Last updated March 2005

HYPERNATREM A E)* ,olume expansion.es No 5eig$t lossEx%essive Na $ain .es No &'i(t o( )ater (rare) r$a0domyolysis +esponse to %&' .es No

6in urine ,ol and max urine osm.es Non*renal )ater loss No

,entral +

Nep'ro$eni% +

DGIM Last updated March 2005

Hyper/alaemia

&purious WBC pltlets

True

Re-istri.ution (eg due to acidosis)

/o! G*+

G*+ > 20ml:min

0o) Al-osterone
)%' %ddison7s d8 'yporenin $ypoaldosteronism &rugs 9 $eparin, cyclosporine, captopril

Hi$'1Normal Al-osterone
2u0ular $yper3alaemia %c;uired pseudo$ypoaldosteronism &rugs < pironolactone

DGIM Last updated March 2005

Hypo/alaemia
Exclude redistri0ution o( 4=

Extra renal loss

Renal 3+ loss 2P

># Plasma Renin

Normal ># 4H,O56

&ecreased

Raise 6alig '#2 +enal ?ascular d8 +enin<secreting tumour

Urine ,l*

+e%rease +enal 2u0ular %cidosis

#lasma %ldosterone

789 mmol1 ?omiting

:89 mmol1 >artter7s diuretic

Raise #ri %ldosteronism >ilat adrenal $yperplasia

+e%rease )ongen@ %drenal 'yperplasia )us$ing7s disease

DGIM Last updated March 2005

HYPO3A0EM A Ex%lu-e -ru$ inta/eA insulin, sal0utamol 1r B4C

> 20 mmol:/ Renal loss #lasma B')D"C

< 20 mmol:/ Extrarenal loss #lasma B')D"C

decreased +2% +esp al3alosis

N:increased

decreased %cute diarr$oea

N:increased

&iuretics 6ineralocorticoid excess

)$ronic diarr$oea /axati,e a0use #re,ious diuretics

DGIM Last updated March 2005