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Hyponatremia

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by

Laura Jordan

on 13 June 2013

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Transcript of Hyponatremia

Differential
Blood loss (external injury or internal bleeding)
Fluid loss
Decreased blood clotting ability
Diarrhea or vomiting
Excessive sweating (which can result from heat exposure)
Extremes of age (infants and the elderly may be unable to take fluids)
Kidney diseases resulting in increased urination
Placenta previa (placental tissue on top of the cervix) or abruption (early detachment of the placenta)
Use of diuretics
Large burns
Inadequate fluid intake

Differential
Blood transfusion reaction
Chronic liver disease/liver failure
CHF
Cushing's syndrome
Hyperaldosteronism
Kidney failure
Lung problems
Nephrotic syndrome
Preeclampsia
Pregnancy
Surgery / operation complications

Differential
Treatment
Work-up
• Serum sodium osmolality
• Urine osmolality
• Urine sodium, potassium, and chloride concentrations



Hyponatremia
by Laura Jordan
• Serum sodium concentration of less than 135 mEq/L as a result of an accumulation of total body water greater than the body's accumulation of electrolytes
• Classification according to volume status
i. Hypovolemic hyponatremia
ii. Euvolemic hyponatremia
iii. Hypervolemic hyponatremia

Hyponatremia Definition
Hypovolemic Hyponatremia
Definition: sodium depletion in excess of water depletion.
Clinical Findings
Dry mucous membranes
Loss of skin elasticity
Decreased urine output.
Change in mental status
Weak pulse
Headache
Nausea/vomiting
Orthostatic or persistent hypotension
Seizures (due to cell swelling and disturbances in CNS)

Euvolemic Hyponatremia
Definition: normal body sodium with increase in total body water
Clinical Findings
Low urine output
Increased urine osmolality

SIADH (most common cause)
Tumors
CNS disorders (trauma, subarachnoid hemorrhage, tumors, infections, encephalitis, Guillain-Barré syndrome, and acute psychosis)
Hypothyroidism
Glucocorticoid deficiency
Excessive oral fluid intake
Postop period (transient increase in ADH)
Drugs
Antipsychotic agents
Antidepressants
Anticonvulsants
ACE inhibitors
MDMA or "ecstasy"
Oxytocin

Hypervolemic Hyponatremia
Definition: increase in total body sodium with greater increase in total body water
Clinical Findings
Ascites
Crackles on auscultation
Edema - particularly hands, feet, and ankles
Difficulty breathing while lying down
High blood pressure
Irritated cough
Jugular vein distension
Shortness of breath
Strong, rapid pulse

https://online.epocrates.com/u/292157/E
Hypovolemic Hyponatremia
Controlling loss of fluid or blood
Replacing those fluids and blood
Restoring circulation
Examples
Blood plasma transfusion
Cryoprecipitate transfusion (provides fibrinogen, required for clotting)
Intravenous colloids (solutions containing complex sugars known as dextrans, proteins, or starches)
Intravenous crystalloids (salt solutions)
Platelet transfusion
Red blood cell transfusion
Vasopressors (medications such as norepinephrine, epinephrine, dopamine, and vasopressin that increase the blood pressure)
Euvolemic Hyponatremia
Treatment of underlying condition; Ex.
moderate SIADH give hypertonic saline
Hypervolemic Hyponatremia
Treatment of underlying cause
Sodium restriction
Fluid restriction
Diuretics
ACE inhibitors
Angiotensin receptor blockers
Thank you!
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