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Hyponatremia By Ehealthguide.info
By Dr. D.S. Merchant
Sodium Balance:
•The human body contains 1 g Na / Kg of BW
•Sodium is located:95% extracellularly
5% intracellularly.
•Daily balance of sodium is 6 gr (150 meq)
•Daily losses = 150 meq = 100 meq in urine + 35 meq in sweat + 15 meq in feces
Sodium reabsorption
•Sodium is reabsorbed almost completely
(~ 99% ) esp. in proximal tubule.
•The percent amount of sodium that is excreted in the urine is called F•Na and is calculated by the formula:
FENa (%) = Urinesodium/Plasmasodium X 100
Urinecreatinine/Plasmacreatinine
Hyponatremia:
Plasma Na < 135meq /L
•Almost always due to •ADH Secretion
•Appropriate
•Inappropriat
•One Exception: Primary Polydipsia • supression of ADH Secretion BUT still overwhelms kidney’s diluting ability • Free water retention & Hyponatremia
Epidemiology of Hyponatremia:
Hyponatremia is among the most common electrolyte disorders encountered in clinical medicine, with an incidence of 0.97% and a prevalence of 2.48% in hospitalized adult patients when plasma [Na+ ] concentration below 130 mEq/L is the diagnostic criterion.
Clinical Manifestations:
•< 125 mEq/l •
•Malaise - Muscle cramps
•Nausea, Vomiting, Headache
•Hypotension – Tachycardia
•< 110 mEq/L •
•Confusion, convulsions, coma
Type of Hyponatremias:
1) Hypotonic hyponatremias:
•Hypervolumic
•Euvolumic
•Hypovolumic
2) Hypertonic hyponatremia
3) Isotonic hyponatremia
Hypovolemic Hypotonic Hyponatremia:
•Primary Na loss • Secondary Water gain
Renal Losses (FENA > 1%)
•Diuretics
•Hypoaldosteronism
•Salt-wasting Nephropathy
Extra-renal Losses (FENA < 1%)
•GI losses
•Third Spacing
•Insensible losses
Euvolemic Hypotonic Hyponatremia:
•Psychogenic Polydipsia:
•Requires intake of >10 L/day
•Uosm < 100 mosm/kg
•Low Uric Acid
•Reset Osmostat:
•ADH physiology reset to secrete at subnormal serum osmolality threshold (<280 mosm/kg)
•Seen in: Elderly, Pulmonary processes (e.g. TB), Malnutrition
Euvolemic Hypotonic Hyponatremia:
•SIADH
•Diagnostic Criteria:
•Euvolemic state
•Normal renal, thyroid and adrenal function
•Hypoosmolar serum (<270 mosm/Kg)
•Inappropriately
concentrated urine (>100 mosm/Kg)
•High urinary Na (>40 meq/L) with normal salt and water intake
•Etiologies:
•Endocrinopathies: Hypothyroidism, Adrenal Insufficiency
•Pulmonary Pathology: Pneumonia, Asthma, COPD, PTX
•Intracranial Pathology: Trauma, Infection, Hemorrhage
•Malignancies: Small Cell Lung ca. Intracranial Tumors
•Drugs: Antipsychotic, Antidepressants, Thiazides
Hypervolemic Hypotonic Hyponatremia:
•Decreased Effective Arterial Volume
•Congestive Heart Failure
•Cirrhosis
•Nephrotic Syndrome
•Advanced Renal Failure
Workup:
•Determine Tonicity…
•Osmolality = 2 (Na meq/L) + Glucose(mg/dl) + BUN(mg/dl)
18 2.8
For Hypotonic Hyponatremia:
•Determine Volume Status…
Treatment:
•Hypovolemic Hyponatremia:
•Volume replacement with 0.9% NaCl
•Na Deficit =
0.6 X Body Wt. X (140 – Measured Na) (X 0.85 in women)
•Hypervolemic Hyponatremia:
•Sodium Restriction to 1-3 g/day
•Water Restriction: 1.0-1.5 L/day
•Diuretics
•Na <110 meq/l + CNS symptoms: judicious administration 3% saline with diuretics
•Emergency dialysis
•Euvolemic hyponatremia :
•Free Water Restriction
•Careful Na correction
•Asymptomatic but Na <120 meq/l : 0.9% saline + frusemide maybe used
•In case of Neurological Emergencies
•Loop Diuretics + Fluid Replacement with Hypertonic Saline ( 3% )
•If Chronic • Demeclocycline 300-600 mg twice daily
•Fludrocortisone
•Selective vasopressin V2 antagonist Article Source: Article Beam - a service of A1 Web Server Web Hosting Dr. D.S. Merchant is a Gold Medalist in (Anatomy & Histology), Resident AKUH, Pakistan. For more information on Medicine or visit www.EzineValley.com is a popular website that offers information on Hyponatremia, Type of Hyponatremias and Epidemiology of Hyponatremia.
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