FN: Hyponatraemia Flashcards Preview

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Flashcards in FN: Hyponatraemia Deck (22):
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Presentation

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Presentation

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Causes

Hypovolaemia
Hypervolaemic
Euvolaemic

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Hypovolaemia

U Na >20 mM (=renal loss)

U Na >20mM (=extra-ranal loss)

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U Na >20 mM hypovolaemia = renal loss causes

Diuretics
Addisons
Osmolar diuresis (e.g. glucose)
Renal failure (diuretic phase)

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Hypervolaemia hyponatraemia causes

Cardiac failure
Nephrotic syndrome
Cirrhosis
Renal failure

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Hypervolaemia hyponatraemia causes

Cardiac failure
Nephrotic syndrome
Cirrhosis
Renal failure

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Causes

Hypovolaemia
Hypervolaemic
Euvolaemic

9

Hypovolaemia

U Na >20 mM (=renal loss)

U Na >20mM (=extra-ranal loss)

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U Na >20 mM hypovolaemia = renal loss causes

Diuretics
Addisons
Osmolar diuresis (e.g. glucose)
Renal failure (diuretic phase)

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U Na >20 mM hypovolaemia = extra renal loss

Diarrhoea
Vomiting
Fistula
SBO
Burns

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Hypervolaemia hyponatraemia causes

Cardiac failure
Nephrotic syndrome
Cirrhosis
Renal failure

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Euvolaemic U osmolality >500

SIADH

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Euvolaemia U osmolality

Water overload
Severe hypothyroidism
Glucocorticoid insufficiency

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Management

- correct underlying cause
- Replace Na and water at the same rate they were lost
- asymptomatic chronic hyponatraemia - fluid restrict
-S ymptomatic/acute/dehydrated - cautious rehydration with 0.9% Ns
If hypervolaemia consider frusomide
Emergency seizures/coma: consider hypertonic saline (e.g. 1.8%)

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Replace sodium too fast

central pontine myelinolysis

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Chronic Na loss replacement

10mM/d

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Acute Na loss replacement

1mM/hr

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SIADH

- Concentrated urine: Na>20mM, osmolality >500
- Hyponatraemia or plasma osmolality

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SIADH causes

Resp: SCLC, pneumonia, TB
CNS: meningoencephalitits, head injury, SAH
Endo: hypothyroidism
Drugs: cyclophosphamide, SSRIs, CBZ

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SIADH Rx

Treat cause and fluid restrict
Vasopression recepto antagonists

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Vasopressin receptor antagonist name (2)

- Demclocycline
- Vaptans

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