ASSESSMENT

OF HYPONATREMIA
SERUM OSMOLALITY
Normal 280-285mOsm
Elevated, >285 mOsm
Low, < 280 mOsm

ISOTONIC HYPONATREMIA HYPOTONIC HYPONATREMIA HYPERTONIC HYPONATREMIA

1)Pseudohyponatremia 1)Hyperglycemia
hyperlipidemia 2)Hypertonic infusions
hyperproteinemia glucose ethanol
2)Isotonic infusions
CLINICALLY ASSESS
mannitol sorbitol
glucose ethanol EXTRACELLULAR FLUID
mannitol sorbitol VOLUME STATE (HYDRATION)

ISOVOLEMIC HYPERVOLEMIC HYPOSMOTIC

HYPOVOLEMIC
HYPOSMOTIC HYPONATREMIA
HYPOSMOTIC
HYPONATREMIA
HYPONATREMIA
Urine Na Urine Na <10 >20
>20 <10 >20
<10 (mEq/L) (mEq/L)

Renal losses: Renal failure

DiureVcs, Extrarenal losses: H20 SIADH Nephrosis Acute/chronic
Renal damage, GI (V/D) intox Hypothyroid Cirrhosis renal failure
parVal 3rd space ie Pain/emoVon Heart failure
obstrucVon, PancreaVVs Drugs
Adrenal insu Skin losses Adrenal insu
RTA Lung losses
Salt wasVng
nephriVs

WATER RESTRICT
ISOTONIC SALINE WATER RESTRICT
Facts & Formulas, Rollings RC