Hyponatraemia
- Created by: MazzaW
- Created on: 15-11-19 11:08
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- Hyponatraemia
- Causes
- Pseudohypo-natraemia
- Hyper-glycaemia
- Hypertri-glyceridaemia
- Too much water
- Primary/ psychogenic polydipsia
- IV therapy
- Overdiluted infant formula
- Diabetes insipidus
- Depleted sodium
- Renal loss
- Diuretics
- Salt wasting
- Nephropathy
- Hypo-adrenalism
- Extrarenal loss
- GI loss
- Renal loss
- Reduced renal water clearance
- Hypovolaemia
- Cardiac failure
- Nephrotic syndrome
- Hypo-thyroidism
- Hypo-adrenalism
- SIADH
- Pseudohypo-natraemia
- Symptoms
- Seizures
- Immediate mgmt with hypertonic saline
- Coma
- Immediate mgmt with hypertonic saline
- Coma
- Muscle cramps
- Muscle weakness
- Confusion
- May be asymptomatic
- Drowsiness/ lethargy
- Cerebral oedema
- N+V
- Seizures
- Investigations
- U+Es
- Other electrolytes
- CT head if indicated
- Urine osmolality
- < 100mOsmol/kg
- Too much water
- >100mOsmol/kg
- Urine sodium level
- >30mmol/L
- Diuretics or ACEI?
- If not, consider renal loss (salt wasting, SIADH, hypo-adrenalism)
- Diuretics or ACEI?
- < 30mmol/L
- Heart/liver/ renal failure, GI loss
- >30mmol/L
- Urine sodium level
- < 100mOsmol/kg
- Serum glucose
- Exclude hyper-glycaemia
- Assess fluid status
- Mgmt
- Severe Sx
- Hypertonic saline
- Not too fast- risk of osmotic demyelination
- Hypertonic saline
- Hyper-volaemic or SIADH
- Fluid restrict
- Medications review
- Severe Sx
- Causes
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