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4 Finals > Hyponatraemia > Flashcards

Hyponatraemia Flashcards

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1
Q

What are the signs and symptoms of hyponatraemia?

A 
Anorexia
Nausea
Malaise
Headache
Irritability
Confusion
Weakness
Decreased GCS and seizures
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2
Q

What are the causes of hyponatraemia if the pt is dehydrated and urinary Na >20mmol/l?

A

Renal Na+ loss:

  • Addison’s
  • Renal failure
  • Diuretic excess
  • Osmolar diuresis
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3
Q

What are the causes of hyponatraemia if the pt is dehydrated and urinary Na <20mmol/l?

A

Loss from elsewhere:

  • D&V
  • Fistulae
  • Burns
  • Small bowel obstruction
  • Trauma
  • CF
  • Heat exposure
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4
Q

What are the causes of hyponatraemia if the pt is NOT dehydrated and they are oedematous?

A

Nephrotic syndrome
Cardiac failure
Cirrhosis
Renal failure

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5
Q

What are the causes of hyponatraemia if the pt is NOT dehydrated and they are NOT oedematous AND Urine osmolality >500mmol/kg?

A

Inappropriate ADH

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6
Q

What are the causes of hyponatraemia if the pt is NOT dehydrated and they are NOT oedematous AND Urine osmolality <500mmol/kg?

A

Water overload
Severe hypothyroidism
Glucocorticoid insufficiency

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7
Q

What are the potential artificial causes of hyponatraemia ?

A

Blood smaple from a drip arm
High serum lipid/protein content
Hyperglycaemia

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8
Q

What are the iatrogenic causes of hyponatraemia ?

A

5% glucose infused constantly with no 0.9% saline

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9
Q

What is the management of hyponatraemia ?

A

Correct underlying cause

Replace Na+ and water at same rate lost

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10
Q

What is the management of hyponatraemia in a patient that is asymptomatic/chronic?

A

Fluid restriction - often enough
Demeclocycline may be needed
Max rise of 15mmol/l/day

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11
Q

What is the management of hyponatraemia in apt that is symptomatic/dehydrated/acute ?

A

Cautious rehydration with 0.9% saline
Consider furosemide when not hypovolaemic to avoid overload
Max rise of 1mmol/l/day

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12
Q

What is the role of vasopressor receptor antagonists (vaptans) in hyponatraemia?

A

Treating hyper/eu-volaemic cases

Promotes water excretion without loss of electrolytes

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13
Q

What is the emergency management of hyponatraemia?

A

Seek expert help
Hypertonic saline at 70mmol/h +/- furosemide
Aim for gradual increase
Beware HF and central pontine myelinolysis

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4 Finals (20 decks)

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