Hyponatremia a practical approach pdf

Introduction sodium, an element essential to growth, is contained in bone, cartilage and connective tissue. The new edition of this classic reference offers a problembased approach to pediatric diseases. Hyponatremia is one of the most common disturbances of sodium metabolism in hospital patients, with a prevalence of 2% to 3%. A subscription is required to access all the content in best practice. Practical selection of antiemetics in the ambulatory setting. Request pdf on aug 1, 2011, p gross and others published practical approach to hyponatremia find, read and cite all the research you need on researchgate. Proper interpretation of the various laboratory tests helps to differentiate the various types of hyponatremia.

Clinical practice guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. Nevertheless, it is quite clear that improper management of a hyponatremic patient may result in severe neurologic damage or death. Disturbances in sodium concentration are common in the critically ill patient and associated with increased mortality. Hyponatremia occurs when the concentration of sodium in your blood is abnormally low. Normal range generally falls between 3 to 146 meql, with some variability dependent on individual laboratories. Innovative and practical ideas from thought leaders and experts on improving the value of care delivery. The most common mechanism leading in these cases to hyponatremia is the syndrome of inappropriate secretion of vasopressin siadh. Goal 46 mmoll rapidly over several hours limit 8 mmoll at 24 hours and 16 mmoll at 48 hours unless hyperacute hyponatremia. Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Various research studies have shown that all antidepressants are associated with hyponatremia. Hyponatremia is a common electrolyte disorder in children. A practical approach manisha sahay, rakesh sahay department of nephrology, osmania medical college and general hospital, hyderabad, andhra pradesh, india abstract hyponatremia is an important and common clinical problem. Approach to a patient with hyponatremia ourmedical. Measuring the serum osmolality, urine sodium concentration and urine osmolality will help differentiate among the possible causes.

Sodium disorders are associated with an increased risk of morbidity and mortality. Psychotropicinduced hyponatremia mdedge psychiatry. This paper addresses the basic pathophysiologic concepts about hyponatremia followed by a practical approach to its diagnosis and management. Sodium homeostasis is essential for maintaining intravascular volume and is tightly linked to water balance. Medications are often the cause of acute or chronic hyponatremia. Practical approach to hyponatraemia and hypernatraemia in critically ill patients christian overgaardsteensen 0 troels ring 0 department of neuroanaesthesiology, rigshospitalet, blegdamsvej 9, dk2100 copenhagen, denmark disturbances in sodium concentration are common in the critically ill patient and associated with increased mortality. First,adiagnostic evaluation is aimed at identifying the pathogenesis and putative causes of. Clinical pediatrics for undergraduates download ebook. 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. However, in certain patient populations, they are associated with siadh syndrome of inappropriate antidiuretic hormone secretion and hyponatremia. Ive created a short video on the approach to hyponatremia in the clinic. Hyponatremia is the most frequent electrolyte disorder found in cancer patients. Treatment of hypotonic hyponatremia often challenges clinicians on many counts. Etiology approach for hyponatremia the basic hyponatremia approach is based on clinical history, physical examination, full blood test as described in table 2, timing of the onset of hyponatremia, symptoms, and type of hyponatremia table 4 urine sodium.

Hyponatremia is a common electrolyte disorder defined as a serum sodium level of less than 5 meq per l. Early therapy with fludrocortisone significantly reduced the duration of hospital stay p hyponatremia. Urinary osmolality was 600 mosml, and urinary sodium was 80 mmoll. Sodium is an electrolyte, and it helps regulate the amount of water thats in and around your cells. Practical document on the management of hyponatremia in critically. It therefore seems reasonable to develop a document. The causes of hyponatremia in patients treated in psychiatric wards include. Treatment varies with the nature of onset acute or chronic, severity and symptoms.

Hyponatremia is present when the serum sodium concentration is less than meql mmoll, although some would consider a value less than 5 to be hyponatremic. Hyponatremia is defined as a serum sodium concentration of hyponatremia is present when the serum sodium concentration is less than meql mmoll, although some would consider a value less than 5 to be hyponatremic. Following this, the urine osmolality was sampled and measured at 634 mosmkg. Hyponatremia in the physical states of extracellular fluid ecf volume contraction and expansion can be easy to diagnose but often proves. Risk factors for sodium overcorrection in nonhypovolemic. Hyponatremia is generally classified into mild 5 mmoll, moderate 120129 mmoll, and severe hyponatremia is defined as a decrease in the serum sodium concentration to a level below 6 mmol per liter. If you overshoot by one or two mmol then you will still be well within the safe range. Mar 01, 2015 hyponatremia is a common electrolyte disorder defined as a serum sodium level of less than 5 meq per l. A practical approach includes treatment of the underlying diseases and. Plasma water volume is regulated mainly by the secretion of an antidiuretic hormone adh and by the thirst mechanism.

Hyponatremia is common in both inpatients and outpatients. It is generally defined as plasma sodium of less than 5 mmoll. The diagnosis and management of inpatient hyponatraemia. Hyponatremia is an important and common clinical problem. Hyponatremia is generally classified into mild 5 mmoll, moderate 120129 mmoll, and severe 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. The diagnosis and management of inpatient hyponatraemia and siadh. The treatment of hyponatremia depends on the time course, severity, and underlying cause of the disorder. Hyponatremia and hypernatremia are classified based on volume. Sep 05, 2015 approach to hyponatremia in children 1.

This video provides a practical approach to the analysis of the hypotonic hyponatremia in the clinic. Pdf hyponatremia is an important and common clinical problem. Nejm resident 360 information, resources, and support needed to approach rotations and. Hyponatremia may be euvolemic, hypovolemic or hypervolemic. Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 6 mmol per liter. Hyponatremia symptoms, diagnosis and treatment bmj best. It therefore seems reasonable to develop a document addressing hn in the critical patient from a practical perspective. It is defined as a serum sodium level sna of less than 5 mmoll. Treat neurologic emergencies related to hyponatremia 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. Antidepressants and hyponatremia in a patient with. Within 10 minutes youll learn how to figure out the cause of hyponatremia in your patient, by assessing volume status, and measuring sodium and osmolality in urine. Demographic and clinical data including age, sex, weight, height, comorbidity, cause of hyponatremia. Antidepressants are routinely used by general practitioners gp as well as psychiatrists to treat depression.

Sep 11, 2016 easy and practical approach to diagnosis and management of hyponatremia. Hyponatremia in the physical states of extracellular fluid ecf volume contraction and expansion can be easy to. Normal saline forms the mainstay of treatment for hypovolemic hyponatremia while 3% nacl and fluid restriction are important for euvolemic hyponatremia. Clinical practice guideline on diagnosis and treatment of.

Hyponatremia hn is the most frequent electrolytic disorder in the intensive care unit icu. It encompasses almost all pediatric subspecialties and covers every pediatric disease and organ system. Practical document on the management of hyponatremia in. It is based upon the physiologic responses of the raas and adh system. Choose one of the access methods below or take a look at our subscribe or free trial options. Hyponatremia is defined as a serum sodium concentration of a disorder of water balance reflected by an excess of total body water relative to electrolytes total body sodium and potassium leading to low plasma osmolality i. Frontiers pathophysiology of hyponatremia in children. A systematic approach in the management of a high output. In this study, the risk factors associated with sodium overcorrection were investigated with an optimal cutoff for baseline serum sodium for use in daily clinical practice. Approach to a patient with hyponatremia ibrahim qaqish, md, facp, st.

When the time frame of hyponatremia cannot be established with con. The serum osmolality was measured to be 265 mosmkg and was less the normal range 275295 mosmkg which indicated a diagnosis of hypoosmotic hyponatremia. In hyponatremia, one or more factors ranging from an underlying medical condition to drinking too much water cause the sodium in your body to become. Syndrome of inappropriate antidiuretic hormone in a patient receiving highdose haloperidol and quetiapine therapy. When hyponatremia is first discovered, some elements of the history, key features of the physical exam, and the results of several helpful laboratory tests are usually already available, and these guide the subsequent diagnostic approach algorithm 1. Hyponatremia represents a relative excess of water in relation to sodium. Oct 20, 2017 this video provides a practical approach to the analysis of the hypotonic hyponatremia in the clinic. A step wise approach was employed to evaluate the cause of hyponatremia. Whereas hypernatremia always denotes hypertonicity, hyponatremia can be associated with. Easy and practical approach to diagnosis and management of hyponatremia.