Hyponatremia ☺️ Flashcards

1
Q

Presentation

  • early
  • late
A

Early

  • headache
  • fatigue
  • N+V
  • confusion
  • cramps

Severe

  • seizures
  • coma
  • resp arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What would the U&Es show if a patient had SIADH

What other signs and symptoms might they have?

A
  • Na => low
  • Plasma osmolality => low
  • Urine Na, osmolality => high

Urea, creatinine => normal, not dehydrated

No postural hypotension (characteristic of Addisons)
Nausea, weakness, dizziness
Normal TFT, adrenal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Possible causes

A

Hypo hypo

  • diuretic
  • Addisons

Normo hypo
-SIADH (antipsychotics, mood stabilisers, lung cancer, infections)

Hyper hypo
-CF, LF, nephrotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How would you manage hyponatremia caused by SIADH

A

Fluid restriction
Demeclocycline - block ADH
Tolvaptan - ADH antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Investigations and diagnosis

  • hypovolemic
  • normovolemic
  • hypervolemic
A
Hypovolemic
Urine Na 20+
-diuretics
-Addisons
-CKD

Urine Na U20 - extrarenal loss
-diarrhoea, vomit, sweat, burns

Euvolemic - urine Na 20+

  • SIADH
  • hypothyroid

Hypervolemia - urine Na U20

  • HF, cirrhosis
  • nephrotic
  • excess fluids
  • psychogenic polydipsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Consequences of

  • untreated severe hyponatremia
  • overrapid correction
A

Cerebral edema => brain herniation

Osmotic demyelination syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management for chronic without severe symptoms

  • hypovolemic cause
  • normovolemic cause
  • hypervolemic cause
A

Hypo - isotonic saline

  • if serum Na rises => hypo hypo
  • if serum Na falls => SIADH

Normo - fluid restriction
-address underlying cause

Hyper - fluid restriction, loop diuretics, vaptans
-address underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management for acute with severe symptoms

A

HDU/ICU monitoring

Hypertonic saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly