Types of hyponatremia:

1.hypertonic hypo Na: normal tot. body sodium

and dilutional drop in the measured Na due to the
presence of osmotically active molecules (e.g.
mannitol that is used to treat brain oedema or
maltose.) which causes water shift from
intracellular to ex.cullular compartment.
2.isotonic hypo.Na (pseudohyponatremia):
Severe hyperlipidemia and paraproteinemia
Less water fraction in plasma( less than 92%)
Less measured Na, due to the decrease in
Water fraction ( although Na to water or plasma
ratio is not changed) so it’s considerd artifactual
decrease.
3.Hypotonic hyponatremia:
-hypovolemic hypotonic hypoNa:
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Thiazide (unlike loop diu.) causes more Na.

excretion leading to hypo.hypo.hypo.
-hypervolemic hypotonic hypoNa:
Occurs in case od edema or ascites ( due to liver
cirrhosis, h.f., etc.). there is an increase in tot. body
water, paradoxically a decrease in effective
circulating volume, critical for tissue perfusion
( most of fluid is intracellular or intrastitial while
intravascular volume is decreased) this leads to the
activation of previous mechanism ( in the chart)
Of hypo.hypo.hypo.
-euvolemic hypotonic hypoNa. : common in
hospitalized pts. Associated with SIADH
( nonosmotic and non volume related antidiuretic
hormone (vasopressin) secretion that occurs due to
medications, hypopituitarism, stress, trauma,
surgery, infection, etc.)
**vaspressin causes more water reabsorbtion and
no effect on Na reabsorption in kidney tubules. The
second effect is arteriolar constriction and rise in
arterial blood pressure.
Hypernatremia
**how thirst occurs?
High osmolality of body fluid lead to the release of
vasopressin and to stimulate thirst in
hypothalamus, how? High osmolality body fluids
absorp fluid of neural cells of nerves causing their
shrinkage and give signal to release vasopressin and
thirst in response to hyperosmolality or
hypovolemia. This is a very sensitive mechanism
that by which it’s almost impossible that
hypernatremia occurs un a healthy individual.