Causes of hypernatremia involve a net gain of sodium or a loss of free water. 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. 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. Hyperosmotic measure serum osmolality isoosmotic osmotic hyponatremia hypoosmotic hyperlipidemia mannitol hyperglycemia hyperproteinemia. Hyponatremia is defined as a serum sodium concentration of hyponatremia. Hyponatremia oxford medicine oxford medicine online. Unfortunately, as is true of all electrolyte disturbances, there are no randomized trials to guide the treatment of this challenging.
A simple way of looking at hypoatremia compiled from algorithms found online. The fourth edition focuses on the most commonly encountered problems in hospital medicine, presented in a handy userfriendly outline. In general, static measurements of intravascular blood volume e. Clinical physiology of acidbase and electrolyte disorders. Measuring the serum osmolality, urine sodium concentration and urine osmolality will help differentiate among the possible causes. Hyponatremia may be euvolemic, hypovolemic or hypervolemic. Hyponatremia happens when too much sodium leaves your body, or when more water than sodium stays in your blood. Therefore, a logical, rigorous differential diagnosis is mandatory before therapy can be begun. 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.
Figure 2 algorithm for the approach to hyponatremic patient. Pocket notebook pocket medicine fourth edition edited by marc s. Hyponatremia is a low sodium concentration in the blood. 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. Linkedin reddit whatsapp gmail telegram pocket mix tumblr amazon wish list. Ccsap 2018 book 3 fluids and nutritiongi and liver disorders 8 fluid and hyponatremia management or large body habitus. Problems with this algorithm include the following. Acute hyponatremia is defined as hyponatremia serum na. Hyponatremia symptoms, diagnosis and treatment bmj. 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. 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. The mdpocket resident edition is the best pocket medical reference guide for residents and interns in training or during residency. 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.
This issue provides a clinical overview of hyponatremia, focusing on prevention, diagnosis, treatment, and practice improvement. Crrt has advantages in its ability to correct plasma sodium values in a predictable and slow manner 3,4. Medications are often the cause of acute or chronic hyponatremia. Clinical practice guideline on diagnosis and treatment of. Hyponatremia algorithm reproduced with permission of dr. Hyponatremia occurs when the amount of sodium salt in your blood is lower than normal. Hyponatremia in the physical states of extracellular fluid ecf volume contraction and expansion can be easy to diagnose but often proves. Treatment involves restricting water intake and promoting water loss.
In bulleted lists, tables, and algorithms, pocket medicine provides key clinical information about common problems in internal. Guidelines for the management of hyponatraemia in hospitalised patients authors. 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. Diagnosis and treatment of hyponatremia american journal. It is generally defined as a sodium concentration of less than 5 mmoll 5 meql, with severe hyponatremia being below 120 meql. The serum sodium concentration and thus serum osmolality are closely controlled by water homeostasis, which is mediated by thirst, arginine vasopressin, and the kidneys.
Nimmo md frcpe ffarcsi consultant physician intensive care and medical education wgh and the university of edinburgh nhs lothian. 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. Pdf hyponatremia is a common electrolyte disorder in children. Dx schema hyponatremia the clinical problem solvers. A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. The massachusetts general hospital handbook of internal. This collaboration is designed to provide a rapid but thoughtful initial approach to medical problems seen by house officers with great frequency.
Washington manual, epocrates, and sanford guide apps as an intern instead. Hyponatremia is an imbalance in electrolytes, where there is low serum sodium than the normal level. Hyponatremia is common in both inpatients and outpatients. Severe symptoms include confusion, seizures, and coma. 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. Follow up with your healthcare provider as directed. Principles of management of severe hyponatremia journal. Continuous dialysis for the correction of hyponatremia. Pdf pathophysiology of hyponatremia in children researchgate. Syndrome of inappropriate secretion of antidiuretic hormone. Hyponatremia represents a relative excess of water in relation to sodium. Hyponatremia endocrine and metabolic disorders merck.
Hyponatremia not so fun facts not as asymptomatic as you might think gait instability, falls and fractures for na 124 mmoll renneboog b. 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. Approach to hyponatremia according to the clinical setting. Normal range mild hyponatraemia moderate hyponatraemia severe hyponatraemia. Hyponatremia is a topic covered in the washington manual of medical therapeutics to view the entire topic, please sign in or purchase a subscription the washington manual of medical therapeutics helps you diagnose and treat hundreds of medical conditions. Hyponatraemia symptoms, diagnosis and treatment bmj. Vapotherm emergency medicine pocket guide 2 hivni cannula selection hivni cannula sizes flow range tip od premature 18 lmin 1. Mild symptoms include a decreased ability to think, headaches, nausea, and poor balance. We searched medline, embase, and websites of guideline organizations and professional societies to september 2014 without language restriction for. Hyponatremia, the most common electrolyte disorder encountered, is associated with increased morbidity and mortality even in its milder forms. Treatment varies with the nature of onset acute or chronic, severity and symptoms.
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. Sodium is an electrolyte mineral that helps your muscles, heart, and digestive system work properly. In bulleted lists, tables, and algorithms, pocket medicine provides key clinical information about common problems in all areas of internal medicine. The massachusetts general hospital handbook of internal medicine pocket notebook by marc s.
Drinking too much water or receiving too much fluid through an iv. The normal serum sodium concentration is 5145 meql. Hyponatremia is an important and common clinical problem. 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. Multiple organizations have published guidance documents to assist clinicians in managing hyponatremia. Posm, uosm and una posm confirms hyponatremia is real. Within minutes after the development of hypotonicity, water gain causes swelling of the brain and a decrease in osmolality of the brain. Society of nephrology sin, and italian association of medical. Effects of hyponatremia on the brain and adaptive responses.
Proper interpretation of the various laboratory tests helps to differentiate the various types of hyponatremia. To provide guidelines for appropriate investigations and treatment of hyponatraemia in hospitalised patients. Treatment of severe hyponatremia american society of. Saintchopra guide to inpatient medicine oxford medicine. 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.
Treatment involves fluid restriction plus treatment of the underlying cause. We aimed to explore the scope, content, and consistency of these documents. If the normal body sodium levels do not change with the increase in total body water, the condition is said to be euvolemic hyponatremia. Hypervolemic hyponatremia occurs when there is an increase in total body sodium along with the increase in total body water. Treat neurologic emergencies related to hyponatremia.
Hyponatremia in the physical states of extracellular fluid ecf volume contraction and expansion can be easy to. 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. Hyponatremia causes, algorithm, correction and treatment. 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. Intense and prolonged exercise that causes excessive sweating. Hyponatremia washington manual of medical therapeutics. Any of the following conditions can lead to hyponatremia. 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. Pocket medicineis the joint venture between house staff and faculty expert in a number of medical specialties. Features a convenient pocket size for easy access to key information. Above is the diagnostic algorithm in harrisons principles of internal medicine.
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