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Renal > 1: Hyponatraemia > Flashcards

1: Hyponatraemia Flashcards

1
Q

What is hypotonic hyponatraemia

A
  • Hypernatraemia

- Low serum osmolality

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2
Q

How can causes of hypotonic hyponatraemia be divided

A
  • Hypovolaemia
  • Euvolaemia
  • Hypervolaemia
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3
Q

What is hypovolaemic hyponatraemia

A

There is large loss of sodium with associated small loss of water

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4
Q

What are the renal causes of hypovolaemic hypontraemia

A
  • Diuretics

- Osmotic Diuresis

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5
Q

What are the extra-renal causes of hypovolaemic hyponatraemia

A

Diarrhoea
Vomitting
Burns
Cerebral salt-wasting

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6
Q

What is cerebral salt wasting syndrome

A

Low sodium and dehydration in response to head trauma or tumour

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7
Q

What is euvolaemic hyponatraemia

A

When serum sodium remains the same, however there is an increase in total body water. However, as water is increased in vascular and not interstitial space, it does not cause oedema

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8
Q

How can euvolaemic hyponatraemia be divided

A
  • Increase urine osmolality (concentration)

- Decrease urine osmolality (concentration)

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9
Q

What causes euvolaemic hyponatraemia with concentrated urine (high urine osmolality)

A
  • SIADH

= increase water reabsorption leaves concentrated urine and dilute plasma

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10
Q

What causes euvolaemic hyponatraemia with dilute urine (low urine osmolality)

A
  • Psychogenic polydipsia
  • Pottomania
  • Hypothyroidism
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11
Q

What is potomania

A

Excess beer intake

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12
Q

What is hypervolaemia hyponatraemia

A

Excess water, with relatively small increase in sodium

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13
Q

What causes hypervolaemic hyponatraemia

A

CHF
Liver cirrhosis
Nephrotic syndrome

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14
Q

What is isotonic hyponatraemia

A

Same serum osmolality

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15
Q

What causes isotonic hyponatraemia

A

Pseudohyponatraemia

Paraproteinaemia

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16
Q

What is Pseudohyponatrarmia

A

Increase in lipids and proteins - interferes with measurement of sodium

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17
Q

What causes paraproteinaemia

A

Myeloma

18
Q

What is hypertonic hyponatraemia

A

Increase serum osmolality

19
Q

What causes hypertonic hyponatraemia

A

Hyperglycaemia

Cushing’s Disease

20
Q

What are the symptoms of hyponatraemia

A

N+V

Weakness

21
Q

What does severe hyponatraemia cause

A

Cerebral Oedema

22
Q

How does cerebral oedema present

A

Confusion
Seizures
Death

23
Q

What are the two mechanisms of hyponatraemia

A
  1. Loose more sodium than water

2. Gain more water than sodium

24
Q

What is first-line investigation for hyponatraemia

A

U+E

25
Q

How will U+Es present in hyponatraemia

A

Low sodium

26
Q

What is second-line for investigating hyponatraemia

A

Serum osmolality

27
Q

How is serum osmolality calculated

A

2Na + Glucose + Urea

28
Q

If serum osmolality is low, what does it indicate

A

True hyponatraemia.

= Loss of sodium will cause a low serum osmolality

29
Q

what is a ‘true’ hyponatraemia also known as and why

A

Hypotonic hyponatraemia

= Low sodium causes reduction in serum osmolality and therefore hypotonic

30
Q

what does a normal serum osmolality indicate and why

A

Pseudohyponatraemia.

There is no loss of osmotic particles which contribute to serum osmolality measurement. However there is a gain of lipids and protein which disrupt sodium measurement in U+E

31
Q

what does a high serum osmolality indicate and why

A

Raised glucose

32
Q

after working out serum osmolality, what is calculated

A

urine osmolality

33
Q

what urine osmolality indicates concentrated urine

A

> 500

34
Q

what does a high urine osmolality and hyponatraemia indicate and why

A

SIADH

  • Increase ADH causing water reabsorption. This means more concentrated urine (high osmolality).
  • Increase water dilutes sodium causing hyponatraemia
35
Q

how is hyponatraemia managed

A
  • Treat cause

- Hypertonic saline

36
Q

explain correction of hyponatraemia

A

Needs to be corrected slowly at a rate of 4-6mmol/L in 24h

37
Q

why is hyponatraemia corrected at 4-6mmol/L in 24h

A

Too rapid correction causes cerebral pontine myelinolysis

38
Q

when do symptoms of hyponatraemia present

A

Days-after

39
Q

what are symptoms of cerebral pontine myelinolysis

A

Presents as ‘locked-in’ syndrome patients are awake but:

  • Quadraplegia
  • Paraparesis
  • Dysarthria
  • Dysphagia
  • Seizures
40
Q

is cerebral pontine myelinolysis reversible

A

Yes

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