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Endocrinology > Hyponatraemia > Flashcards

Hyponatraemia Flashcards

1
Q

Definition of hyponatraemia

A

serum sodium < 135 mmol/l

Biochemical Severe: serum sodium < 125 mmol/l

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2
Q

Normal serum sodium:

A

135-144mmol

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3
Q

What are the moderate symptoms of hyponatraemia?

A

Most patients have very few signs and symptoms initially

Headache
Irritability
Nausea / vomiting
Mental slowing
Unstable gait / falls
Confusion / delirium
Disorientation

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4
Q

What are the more severe symptoms of hyponatraemia (acute or chronic)?

A

Stupor / coma
Convulsions
Respiratory arrest

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5
Q

What happens to the brain in hyponatraemia?

A

Normal brain (immediate effect of hypotonic state)> Water gain (low osmolality) brain gains water gets bigger causes headaches and causes symptoms (Rapid adaptation) > loss of Na, K, Cl (low osmolality) (Slow adaptation) > Loss of organic osmolytes (low osmolality)

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6
Q

What are the biochemical classifications of Hyponatraemia?

A

Mild 130-135mmol/l
Moderate 125-129mmol/l
Severe <125mmol/l

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7
Q

What is aetiology of Hyponatraemia?

A

Hypovolaemic
Euvolaemic
Hypervolaemic

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8
Q

What is the acuity of onset for hyponatraemia?

A

Acute < 48 hours
Chronic > 48 hours

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9
Q

What is the general treatment for hyponatraemia?

A

Stop hypotonic fluids
Review drug card/ chart – long list - PPI etc.

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10
Q

What are the specific tests you need to do for hyponatraemia?

A

Plasma and Urine Osmolality
Urinary Na+
glucose
TFT’s
+/- Assessment of Cortisol
Assessment of underlying causes eg chest imaging

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11
Q

What can happen with fluid overloaded hyponatraemia and how can we treat it?

A

Cirrhosis of liver/liver failure
Congestive Cardiac failure

Fluid Restrict 500 - 1000ml / 24hrs

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12
Q

What can happen with normovolaemic hyponatraemia and how do we treat it?

A

Fluid Restrict 500 - 1000ml / 24hrs

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13
Q

What happens if you have low urine Na?

A

Vomiting and diarrhoea
Burns
Pancreatitis
Sodium depletion after diuretics

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14
Q

What happens if you have urine Na >40mmol/L?

A

Diuretics
Addison’s (or occasionally pituitary failure)
Cerebral salt wasting
Salt wasting nephropathy

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15
Q

What treatment do you have for low urine Na or Urine Na >40mmol/L?

A

Saline replacement

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16
Q

What is SIAD?

A

syndrome of antidiuresis

17
Q

Features of SIAD?

A

Too much AVP, when it should not be being secreted
Low osmolality
Plasma sodium is low
Urine is inappropriately concentrated
Water retention - ECF volume increased mildly
Increase GRF - less Na reabsorption in PCT
thus - urine Na+ usually >30mmol/l
normal thyroid and adrenal function

18
Q

Causes of SIAD:

A

CNS disorders: Meningitis, Brain tumour, encephalitis etc
Tumours: Carcinomas, lymphomas, leukaemia etc
Respiratory causes: Pneuomonia, Tuberculosis, Severe asthmas
Drugs: Thiazides, PPI’s, oxytocin etc

19
Q

What are the treatment goals of SIAD?

A

ensure correct diagnosis
facilitate increase in serum Na+
treat any underlying condition
identify and stop any causative drug (if possible)
in acute setting - daily U+E - hospital
in chronic setting - weekly to monthly U+E - hospital/GP
frequent co-morbidity
Na+>130 mmol/l - usually no need for urgent intervention

20
Q

What is the management of SIAD?

A

Diagnose and treat underlying condition

fluid restriction <1L/24 hour

sometimes demeclocycline/ vaptan – acts on collecting duct

if Na+ <115 mmol/l AND fitting hypertonic N/Saline on ITU

<8mmol/l increase in Na+ per 24 hour if chronic

Potential risk of central pontine myelinolysis

21
Q

Brain and hyponatremia: Treatment after loss of organic osmolytes

A

Improper therapy: Rapid correction of the hypotonic state - Leads to osmotic demyelination
Proper therapy: Slow correction of the hypotonic state - Normal brain normal osmolality

22
Q

What is osmotic demyelination syndrome?

A

White areas in the middle of the pons

Massive demyelination of descending axons

May take up to 2 weeks to manifest

23
Q

What are the risk factors for Osmotic Demyelination Syndrome (ODS)?

A

Serum Na+ <105mmol/L
Hypokalaemia
Chronic excess alcohol
Malnutrition
Advanced Liver disease
>18mmol/L Na+ increase in 48 hour

Endocrinology (17 decks)

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