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Hyponatremia
• Hyponatremia is defined as a plasma sodium less than
135 mEq/L
• A true hyponatremia is characterized by hypo-
osmolality
True Hyponatremia (Hypo-osmolar hyponatremia)
• Hyponatremia with normal ECF volume
• SIADH, Hypothyroidism, Glucocorticoid deficiency
• Post operative pain
• Psychogenic polydipsia
• Hyponatremia with increased ECF(Hypervolemia)–Dilutional
hyponatreamia
• Cardiac Failure
• Cirrhosis
• Nephrotic Syndrome
• Renal Failure
• Hyponatremia with low ECF (Hypovolemia)
• Renal loss – Diuretics, osmotic diuresis, salt wasting nephropathy
• Extra renal cause – vomiting, diarrhoea, peritonitis
Psudo hyponatremia and SIADH
• Pseudo Hyponatremia
• Normal osmolality – Hyperlipidemia, hyperproteinemia
• High osmolality – Hyperglycaemia ( Plasma Na+
concentration falls by 1.4 mmol/L for every 100 mg/dL
rise in the plasma glucose concentration)
• Syndrome of inappropriate ADH secretion (SIADH) —
• Persistent ADH release and water retention can be seen in
SIADH.
• Major causes of SIADH include CNS disease, malignancy /
mainly lung, certain drugs, and post-surgery.
SIADH diagnostic criteria
• Patients are typically normovolemic
• Low plasma sodium concentration (typically < 130 mmol/l)
• Low plasma osmolality (< 270 mmol/kg)
• Inappropriately concentrated urine - Urine osmolality elevated(> 100
mmol/kg)
• Urine sodium concentration elevated (>40 mEq/L)
• By definition, they also should have normal renal, adrenal, and thyroid
function and usually have normal K+ and acid-base balance.
• SIADH may be associated with hypouricemia due to the uricosuric state
induced by volume expansion.
• Exclusion of other causes of hyponatremia
Clinical features
Mild hyponatremia Moderate Severe