Hyponatraemia and Hypernatraemia

Question 1

Hyponatraemia

Answer 1

Very low sodium level <135 mmol

Question 2

Clinical features of hyponatraemia

Answer 2

• Lethargy
• Nausea
• neurological impairment - headache//confusion//seizures

Question 3

Causes of hyponatraemia

Answer 3

1. Water intoxication - excessive water intake such as ecstasy use
2. Extrafluid overload states - heart failure, kidney disease, ascites, oedema
3. Addision’s disease
4. Hypothyroid
5. Diuretics
6. Diarrhoea
7. Syndrome of inappropriate antidiuretic hormone secretion

Question 4

SIADH

Answer 4

diagnose in normovolemic patient when serum sodium is <130mmol
• urine osmolarity exceeds plasma osmolarity in absence of diuretic use//renal dysfunction//hypothyroidism//adrenal insufficiency etc

Question 5

Hypernatraemia

Answer 5

Excess levels of sodium >142 mmol

• less common as rise in plasma osmolarity triggers ADH release and thirst

Question 6

Causes of hypernatraemia

Answer 6

• diabetes insipidus ??

Question 7

clincial features of hypernatraemia

Answer 7

• nausea
• vomitting
  -lethargy
• seizure
  coma

Question 8

management of hypernatraemia

Answer 8

1. Diabetes insipidus - desmopression ( adh anologue) should be administered
2. Corrected slowly to avoid cerebral oedema

Question 9

management of hyponatraemia

Answer 9

1. too rapid correction can lead to permenant neurological damage -
2. water restriction
3. sodium and water replacement