Any of the following conditions can lead to hyponatremia. The content of in the clinic is drawn from the clinical information and education resources of the american college of physicians acp, including acp smart medicine and mksap medical knowledge and selfassessment program. Hyponatremia causes, algorithm, correction and treatment. Proper interpretation of the various laboratory tests helps to differentiate the various types of hyponatremia. We aimed to explore the scope, content, and consistency of these documents. Measuring the serum osmolality, urine sodium concentration and urine osmolality will help differentiate among the possible causes. Hyponatremia happens when too much sodium leaves your body, or when more water than sodium stays in your blood. In the event of a seizure, coma or suspected cerebral herniation as a result of hyponatremia, iv 3% hypertonic saline should be administered as soon as possible according to the following guide administer 3% hypertonic saline 100150cc iv over 510min. It provides an easily accessible framework to help students, residents, and inpatient clinicians diagnose and develop treatment and management approaches for a broad range of medical conditions.
Hyponatremia washington manual of medical therapeutics. Dx schema hyponatremia the clinical problem solvers. If the normal body sodium levels do not change with the increase in total body water, the condition is said to be euvolemic hyponatremia. Therefore, a logical, rigorous differential diagnosis is mandatory before therapy can be begun. In bulleted lists, tables, and algorithms, pocket medicine provides key clinical information about common problems in all areas of internal medicine. Hyponatremia is defined as a serum sodium concentration of hyponatremia.
Posm, uosm and una posm confirms hyponatremia is real. Hyperosmotic measure serum osmolality isoosmotic osmotic hyponatremia hypoosmotic hyperlipidemia mannitol hyperglycemia hyperproteinemia. Clinical practice guideline on diagnosis and treatment of hyponatraemia goce spasovski, raymond vanholder1, bruno allolio2, djillali annane3, steve ball4, daniel bichet5, guy decaux6, wiebke fenske2, ewout j hoorn7, carole ichai8, michael joannidis9, alain. Acute hyponatremia is defined as hyponatremia serum na.
Vapotherm emergency medicine pocket guide 2 hivni cannula selection hivni cannula sizes flow range tip od premature 18 lmin 1. Clinical physiology of acidbase and electrolyte disorders. Hyponatremia is an important and common clinical problem. Drinking too much water or receiving too much fluid through an iv. Approach to hyponatremia according to the clinical setting. Linkedin reddit whatsapp gmail telegram pocket mix tumblr amazon wish list. The massachusetts general hospital handbook of internal. Causes of hypernatremia involve a net gain of sodium or a loss of free water. Pocket notebook pocket medicine fourth edition edited by marc s. Society of nephrology sin, and italian association of medical. Because the symptoms of hyponatremia can vary so much from person to person, your doctor will probably order a blood and urine test to confirm the diagnosis. In bulleted lists, tables, and algorithms, pocket medicine provides key clinical information about common problems in internal.
Principles of management of severe hyponatremia journal. Hypervolemic hyponatremia occurs when there is an increase in total body sodium along with the increase in total body water. To provide guidelines for appropriate investigations and treatment of hyponatraemia in hospitalised patients. Treatment involves fluid restriction plus treatment of the underlying cause. Pocket medicineis the joint venture between house staff and faculty expert in a number of medical specialties.
Guidelines for the management of hyponatraemia in hospitalised patients authors. It can be induced by a marked increase in water intake primary polydipsia andor by impaired water excretion due, for example, to advanced renal failure or persistent release of antidiuretic hormone adh. Hyponatremia is an imbalance in electrolytes, where there is low serum sodium than the normal level. Treatment of severe hyponatremia american society of. Hyponatremia symptoms, diagnosis and treatment bmj. Hyponatremia algorithm reproduced with permission of dr. Hyponatremia is common in both inpatients and outpatients. The massachusetts general hospital handbook of internal medicine pocket notebook by marc s.
Crrt has advantages in its ability to correct plasma sodium values in a predictable and slow manner 3,4. Management of severe hyponatremia with continuous renal. The fourth edition focuses on the most commonly encountered problems in hospital medicine, presented in a handy userfriendly outline. The massachusetts general hospital handbook of internal medicine pocket notebook fifth edition this pocket medicine guide is a wonderful mini reference to use whether in school or in practice. Treatment varies with the nature of onset acute or chronic, severity and symptoms. It is one of the common and essential electrolyte abnormalities, which can either be present in isolation or as a resultant complication of the several medical conditions. Sodium is an electrolyte mineral that helps your muscles, heart, and digestive system work properly. Saintchopra guide to inpatient medicine oxford medicine. In general, static measurements of intravascular blood volume e. Follow up with your healthcare provider as directed. Hyponatremia may be euvolemic, hypovolemic or hypervolemic. Hyponatremia is a low sodium concentration in the blood. The serum sodium concentration and thus serum osmolality are closely controlled by water homeostasis, which is mediated by thirst, arginine vasopressin, and the kidneys. Hyponatremia, defined as a decrease in serum sodium below 6 mmoll, is a common occurrence in both inpatients and outpatients and can be found in up to 15% of the general hospital populations.
Because it is designed to fit in the lab coat pocket, and is loose leaf format you have it right at your finger tips when you need it. Hyponatremia endocrine and metabolic disorders merck. We searched medline, embase, and websites of guideline organizations and professional societies to september 2014 without language restriction for. Hyponatremia occurs when the amount of sodium salt in your blood is lower than normal. Hyponatremia represents a relative excess of water in relation to sodium. A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. Ccsap 2018 book 3 fluids and nutritiongi and liver disorders 8 fluid and hyponatremia management or large body habitus. This issue provides a clinical overview of hyponatremia, focusing on prevention, diagnosis, treatment, and practice improvement. Medications are often the cause of acute or chronic hyponatremia. Hyponatraemia symptoms, diagnosis and treatment bmj.
Hyponatremia serum sodium level less than 4 mmoll is a common electrolyte disturbance occurring in a broad spectrum of patients, from asymptomatic to critically ill. Hyponatremia in the physical states of extracellular fluid ecf volume contraction and expansion can be easy to. Intense and prolonged exercise that causes excessive sweating. Problems with this algorithm include the following. Compared with standard hemodialysis machines, where the lowest dialysate sodium concentration is meql due to constraints from the conductivity alarm, crrt solutions can be customized to any desired sodium. It is generally defined as a sodium concentration of less than 5 mmoll 5 meql, with severe hyponatremia being below 120 meql. Unfortunately, as is true of all electrolyte disturbances, there are no randomized trials to guide the treatment of this challenging.
Pdf hyponatremia is a common electrolyte disorder in children. Within minutes after the development of hypotonicity, water gain causes swelling of the brain and a decrease in osmolality of the brain. Hyponatremia defined as a serum sodium concentration of less than 5 meqlis a common and important electrolyte imbalance that can be seen in isolation or, as most often is the case, as a complication of other medical illnesses eg, heart failure, liver failure, renal failure, pneumonia. This collaboration is designed to provide a rapid but thoughtful initial approach to medical problems seen by house officers with great frequency. Treat neurologic emergencies related to hyponatremia. Syndrome of inappropriate secretion of antidiuretic hormone. Hyponatremia in the physical states of extracellular fluid ecf volume contraction and expansion can be easy to diagnose but often proves. Washington manual, epocrates, and sanford guide apps as an intern instead. Features a convenient pocket size for easy access to key information. Above is the diagnostic algorithm in harrisons principles of internal medicine.
The normal serum sodium concentration is 5145 meql. The mdpocket resident edition is the best pocket medical reference guide for residents and interns in training or during residency. Pdf pathophysiology of hyponatremia in children researchgate. Diagnosis and treatment of hyponatremia american journal. In patients with severe symptomatic hyponatremia, the rate of sodium correction should be 6 to 12 meq per l in the first 24 hours and 18 meq per l or less in 48 hours. Hyponatremia, the most common electrolyte disorder encountered, is associated with increased morbidity and mortality even in its milder forms. Normal range mild hyponatraemia moderate hyponatraemia severe hyponatraemia.
Multiple organizations have published guidance documents to assist clinicians in managing hyponatremia. Mild symptoms include a decreased ability to think, headaches, nausea, and poor balance. Hyponatremia oxford medicine oxford medicine online. Renal loss of electrolytefree water due to ureainduced osmotic diuresis has been described as causative in up to 10%. Anton helman, march 2015 hyponatremia is the most common fluid and electrolyte disorder encountered in clinical practice and is found in approximately 20% of admissions to hospital. Effects of hyponatremia on the brain and adaptive responses. A simple way of looking at hypoatremia compiled from algorithms found online. Independent predictor of inpatient mortality reached significance at na hyponatremia is a common electrolyte disorder defined as a serum sodium level of less than 5 meq per l. Clinical practice guideline on diagnosis and treatment of. Figure 2 algorithm for the approach to hyponatremic patient. Nimmo md frcpe ffarcsi consultant physician intensive care and medical education wgh and the university of edinburgh nhs lothian. Hyponatremia is considered as severe if na is hyponatremia treated with hypertonic or isotonic saline infusion, including hypovolemia with hyponatremia and absence of overt neurological manifestations, should be considered as severe because of the risks from saline infusion. Hyponatremia not so fun facts not as asymptomatic as you might think gait instability, falls and fractures for na 124 mmoll renneboog b.
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