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Renal Medicine > Hyponatraemia > Flashcards

Hyponatraemia Flashcards

1
Q

What is Hyponatraemia?

A

serum sodium concentration less than 136mmol/L

<120mmol/L is considered severe

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2
Q

What are the Sx of hyponatraemia?

A
  • anorexia
  • nausea
  • malaise
  • headache
  • irritability
  • confusion
  • weakness
  • low GCS
  • seizure
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3
Q

What are the types of hyponatramia?

A
  • Hypervolemic hyponatraemia
  • Hypovolaemic hyponatraemia
  • Euvolaemic hyponatraemia
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4
Q

What are the causes of hypervolaemic hyponatremia?

A

Urine osmolality <20mmol/L

  • CCF
  • Cirrhosis
  • Nephrotic syndrome
  • Polydipsia

urine osmolality >20mmol/L

  • Renal failure
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5
Q

What are the causes of hypovolaemic hyponatraemia?

A

urine osmolality <20mmol/L

  • Vomiting
  • Diarrhoea
  • Excessive sweat
  • Burns

urine osmolality >20mmol/L

  • Addison’s disease
  • Renal failure
  • Diuretics
  • Cerebral salt wasting
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6
Q

What are the causes of euvolaemic hyponatraemia?

A

Urine osmolality <40mmol/L

  • Acute waterload
  • Psychogenic polydipsia

Urine osmolality >40mmol/L

  • SIADH
  • Glucocorticoid deficiency
  • Severe hypothyroidism
  • Chronic waterload
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7
Q

Broadly describe the Mx of hyponatraemia

A
  • Correct underlying cause
  • Replace same rate as they were lost
  • Tx asymptomatic chronic hyponatraemia or
  • acute/symptomatic hyponatraemia
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8
Q

How would you tx asymptomatic chronic hyponatraemia?

A
  • fluid restriction
  • demeclocycline (ADH antagonist)
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9
Q

How would you tx acute/symptomatic hyponatraemia?

A
  • cautious rehydration c 0.9% saline
  • furosemide - if not hypovolaemic
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10
Q

What happens when you rapidly correct Na?

A

Central Pontine Myelinolysis

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11
Q

What is the max rise in Na serum in chronic and acute?

A
  • Chronic
    • 15mmol/L per day
  • Acute
    • 1mmol/L per hour
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12
Q

How would you diagnose SIADH?

A
  • Con. urine
    • Na > 30mmol/L
    • Osmolality > 100mosmol/kg
  • Hyponatraemia
    • Na < 125mmol/L
    • Osmolality <260mosmol/kg
    • Euvolemia
  • Abscence of
    • hypovolaemia
    • oedema
    • diuretics
    • thyroid and adrenal dysfunction
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13
Q

What are the causes of SIADH?

A
  • Malignancy: sall cell lung cancer, prostate
  • CNS disorder: abcess, stroke, GBS
  • Chest disease: TB, pnuemonia
  • Drugs: opiates, SSRI
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14
Q

How would you Mx SIADH?

A
  • Treat underlying cause
  • Restrict fluids
  • Consider Salt + loop diuretics
  • Vasopressin receptor antagonist (vaptans)
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15
Q

What are the other causes of hyponatraemia?

A
  • SIADH
  • Water overload
  • Severe hypothyroidism
  • Glucocorticoid insufficiency
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16
Q

If you cant remember all, what are the main causes of hyponatremia?

A
  • Thiazide
  • SIADH
  • Addison’s
  • Cirrhosis
  • CHF

Renal Medicine (11 decks)

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