Hyponatremia Flashcards

1
Q

What is the safe limit for rising sodium in hyponatremia

A

8-10mmol/L in 24 hours

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2
Q

Definition of hyponatremai

A

<135 mmol/L Na

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3
Q

What conditions is hyponatremia ass with

A

Heart disease
Liver cirrhosis
Neurological disorders

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4
Q

Grading of hyponatremia levels

A
  • Mild - 130-135
  • Moderate - 125-129
  • Profound <125
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5
Q

Symptoms of hyponatremia

A

Asymtpomatic
Headache
N+V
Muscle cramps
Lethargy

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6
Q

Signs of hyponatremia

A

Disorientation
- Seizures
- Coma
- Cerebral oedema
- Death

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7
Q

What base management of hypoNa off

A

Clinical presentation AND levels

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8
Q

Causes of hyponatremia

A

Reduced renal free water clearance
Pseudohyponatremia - hypertriglyceridaemia
Sodium depletion
Excess water intake
SIADH

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9
Q

Reduced clearance free water -> hyponatremia causes

A
  • Hypovolaemia
    • Drugs
    • Renal failure
    • Portal hypotension and ascites
    • Hypoabuminaemia
    • Sespsis and vascular leak
    • Central salt wasting
    • Fluid sequestration
  • Cardiac failure
  • Nephrotic syndrome
  • Hypothyroidism
  • SIADH, nephrogenic SIADH
  • Hypoadrenalism
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10
Q

Sodium depletion causes

A
  • Renal loss
    • Diuretics
    • Salt wasting/ central SW
    • Nephropathy
    • Hypoaldrenalism
  • Extra renal loss - Gut los
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11
Q

Excess water intake -> hyponatremia causes

A
  • Dipsogenic DI
  • Sodium free hypo-osmolality IV solutuons
  • Dilute infant feeding formulas
  • IV therapy
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12
Q

Essentuak criteria for SIADH

A

Hyponatremia
Clinical euvolaemia
Serum osmolality <275 Osm/kg
Urine osmol >100mOsm/kg
Urina Na .30mmol/L
RULE OUT - see card

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13
Q

What need to rule out in diagnosing SIADH

A

No recent diuretic
Absence of:
Hyotension, hypovolaemia
Non osmotic AVP release
Oedema
Adrenal, thyroid and renal insufficiency

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14
Q

Why is SIADH diangosis of exclusion

A

Because management is fluid restricition which is opposite treatment to most other causes of hyponatremia

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15
Q

Drugs that cause SIADH

A
  • SSRI
  • Carbamazepine
  • Phenothiazines
  • TCAs
  • Cyclophophamide
  • Opiates
  • Vincristine
  • NSAIDs
  • Clofibrate
  • PPIs
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16
Q

CNS causes of SIADH

A

Inflammatory
Tumour
Infection

17
Q

SIADH causes - chest

A

Infection
Structural
Inflammatory eg sarcoidosis
Small lung cell carcinoma

18
Q

Bedisde investigations for SIADH

A

Urine investigations - sodium and osmolality
Plasma
Osmolality
LFTs, bone panel
TFTs
9am cortisol

19
Q

Radiology for SIADH

A
  • CXR
  • Consider CT chest, abdo , pelvis if SIADH confirmed and no cause identified
20
Q

What can cause non hypotonc hyponatremia

A

Hyperglycaemia

21
Q

Causes of urine osmolality ,100mOsmol/kg

A
  • Primary polydipsia
  • Inappropriate IV fluids
  • Low solute intake eg
    • beer potamania syndrome - high volumes of beer (low solute) → hyponatremia
22
Q

Causes of hyponatremia where serum .100mOsmol/kg but urine <30mmol/L

A
  • Low effective atrial volume HF
  • Cirrhosis/portal HPTN
  • Nephrotic syndrome
  • Hypoalbuminaemia
  • Third space loss
  • GI loss
  • Prev diuretic use
23
Q

Causes of hyponatremia where serum .100mOsmol/kg but urine >30mmol/L

A

Diuretics or ACE

24
Q

Mangement hyponatremia

A

Exclude hyperglycaemia
Treat w hypertonic saline if any severe symptoms over 20 mins Otherwise stop non essential pareneteral fluids + meds ass w hyponatremia + treat underlying cause
If clinically well dont try and correct sodium levels

25
Q

Severe symptoms of hyponatremia

A

Coma, seizure

26
Q

What happens in overrapid collection of hyponatremia?

A

Osmotic demyelination sydnomre

27
Q

What does osmotic demyelination syndrome cause

A

Quadriplegia
Opthalmoplegia
Psuedobulbar pasly
Coma
Death

28
Q
A