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DR SATISH K DHAM
SENIOR CONSULTANT(INTERNAL
MEDICINE(IMMUNOLOGY)
UMKAL HOSPITAL GURGAON
HYPONATREMIA
• Defined as serum sodium below 135meq/l
• Mild 130mq/moderate up to 120mq/l and severe<
120mq/l
• Most common disorder of electrolyte, occurring in more
than 22% of hospitalized ICU patients
• Generally considered a disorder of water as against a
disorder of salt,ie results from increased water retention
HYPONATREMIA
• Recognition important as acute severe
hyponatremia can cause significant morbidity and
mortality.
• Rapid correction of chronic hyponatremia can
result in severe neurological complications and
even death.
HYPONATREMIA
• To maintain a normal sodium, ingestion of
water must be matched with an equal
amount of water excretion.
• Any process that limits the elimination of
water, or expands the volume around a fixed
sodium content may lead to decrease in
sodium concentration.
HYPONATREMIA
STEPS REQUIRED FOR THE KIDNEY TO EXCREATE A WATER LOAD
1 Glomerular filtration and delivery of water and electrolytes to the diluting
sites of nephron.
2Active reabsorption of Na and Cl without water in the thick ascending limb of
the loop of Henle.
3 Maintenance of dilute urine due to impermeability of the collecting duct to
water in the absence of ADH.
ABNORMALITES IN ANY OF THE STEPS CAN RESULT IN IMPAIRED FREE WATER
EXCRETION AND HYPONATREMIA
HYPONATREMIA
• Na is mainly extracellular, K is intracellular
• Osmolality is defined as the number of osmoles of solute per kilogram of
solvent Osm/kg.
• Serum osmol = 2(Na)+ BUN/2.8 + Gluc/18
• Sodium is the primary determinant
• Serum osmol tightly regulated (275 – 290)
• Mechanisms for regulation(renal water handling)
• If osmol↑ → 1. thirst mechanism, 2. ADH↑
• ↓Effective circulating volume also → ADH↑
HYPONATREMIA
• Causes of expansion of space around the Na content.
• Pseudohyponatremia Increase plasma protein or lipids.
• Hyperosmolar hyponatremia as seen in hyperglycemia drawing water in ECF
diluting Na(1.6 to2.4meq/l for every 100mg/dl rise in plasma glucose.
• Post TURP Syndrome.Glycine,mannitol,sorbitol can be absorbed in the ECF
during bladder irrigation.
• Psychogenic Polydipsia, beer potomania,tea and toast diet. Water ingested
exceeds the capacity of water excretion by kidneys
PATHOPHYSIOLOGY