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Correspondence from The New England Journal of Medicine — Hyponatremia. Editorial Retrospective from The New England Journal of Medicine — Treatment of Hyponatremia. Resources. Authors & Reviewers · Submit a Manuscript · Subscribers · Institutions · Media · Advertisers · Agents · Permissions · Reprints · NEJM Career Center.

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Step up your salt game. We deconstruct hyponatremia with our Chief of Nephrology, Dr.

Learn the correct steps to diagnose and manage this common and dangerous condition. Full show notes available at http: Join our newsletter mailing list. Rate us on iTunesrecommend a guest or topic and give feedback at thecurbsiders gmail.

She is more fatigued than usual. Listeners will recall the pathophysiology of hyponatremia and develop a systematized approach to identifying the type and cause of hyponatremia, as well as how to safely manage hyponatremia. By the end of this podcast listeners will: I have an ownership bejm in four Davita run dialysis clinics and one vascular access center. He can be reached at thecurbsiders gmail.

Great job as usual! I love that your podcasts have useful evidence based info, that I put into my daily practice. I used to be salty about hyponatremia, but this podcast really cleared things up.

NEJM — The Syndrome of Inappropriate Antidiuresis

You guys have helped me so much on my rotations. Thank you very much you really helped me understanding this hyponatremua pearl ,will be waiting for more nephro. Hello according to uptodate it says hypoaldosteronism would cause hypovolemic, not euvolemic hyponatremia —. Skip to primary navigation Skip to content Skip to footer Step up your salt game. Tonicity and sodium generally move in same direction i. Plasma is liquid component of blood includes clotting factors. Serum is the liquid component of blood after blood has clotted.


Released if hypovolemia, or elevated plasma osmolality.

#48: Hyponatremia Deconstructed

nyponatremia Hypovolemia trumps plasma osmolality. Physical exam can help for grossly hypo- or hypervolemic patients, but euvolemia can be difficult to differentiate from mild hypovolemia, or hypervolemia. Thus if this person ingest 13 L water then 1 L cannot be excreted and sodium will fall. First step, repeat serum sodium measurement! Then check plasma osmolality to determine if true or false hyponatremia.

Sodium is low, but plasma osmolality is normal e. A lab error due to the way sodium is measured. Increased concentration of osmotically active particles e.

Both sodium and plasma osmolality are low. Check urine osmolality, and specific gravity. If ADH independent, specific gravity is 1. Average person with normal renal function must drink more than 18L per day to drop sodium, or more than 2L in an hour e.

Acute renal failure or CKD: Not producing urine, thus water intake can easily exceed output. Dialysis patients hyponatremic predialysis.


Check thyroid panel, cortisol. Patients have very low urine outputs. Often transient and due to stressors e. If persistent, then look for causes like CNS or lung disease, and consider imaging. Treatment is fluid restriction, increased nejk load with salt tabs, or Ure-Naand low dose loop diuretic blunts action of ADH by altering medullary concentration gradient for water. SSRIs, anti-seizure medications, sulfonylureas, opioid narcotics Urine sodium is low hyponaatremia volume depletion, heart failure, and cirrhosis.

If on diuretic, then urine sodium falsely elevated. In cases of decreased renal perfusion e. Antagonize action of ADH in the kidney.


Hyponxtremia of fluid correction: Goal 5 mEq rise in sodium immediately and 10 mEq in first 24 hours. Should be done in ICU. If mild and asymptomatic hyponatremia, then goal 6 mEq rise in sodium per day Max is 12 per day or 0. Shooting for 6 mEq gives a buffer. Hyponatremia algorithm reproduced with permission of Dr.

Musing of a Salt Whisperer blog by Dr. Am J Med Comments Great job as usual! Thanks for the feedback! Thanks for the knowledge. Connect with The Curbsiders.