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Approach to Hyponatremia, diagnosis and treatment.pptx

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martin osodo

treatment of all classes of hyponatremia

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Approach to Hyponatremia Dr. Osodo Martin
Definition Serum Na+ <135mmol/L Affects upto 30% patients
Fluid balance
Hormone in fluid balance ADH/Vasopressin stimulated by increased tonicity(3rd ventricle/hypotholamus) or reduced intravascular volume. ADH increases water reabsorption, Vasopressin receptor 2, in nephron, insertion of aquaporin in apical membrane of the collecting duct. Cortisol Thyroid hormone
Classification
SIADH Commonest cause of euvolemic hyponatremia Diagnosis of exclusion Normal response to hypoNa excretion of dilute urine SIADH reverse occurs hypertonic urine, raised urine sodium
Causes of SIADH
Steps to diagnosis Step 1: Determine Tonicity Hypotonic, hypertonic, isotonic
Approach to Hyponatremia, diagnosis and treatment.pptx
Step 2: Clinical situation and fluid status Euvolemic, Hypovolemic and Hypervolemic
Approach to Hyponatremia, diagnosis and treatment.pptx
Step 3: Urine Osmolality
Step 4: Urine Sodium
Step 5: Any other causes
Approach to Hyponatremia, diagnosis and treatment.pptx
Treatment Prevention is key Stop culprit medication: thiazide, SSRI Correct to 125mmol/l Slow Correction is the way to go In hypovolemia fluid correction with 0.9NaCl, Replace K as well Symptomatic severe hyponatremia correct with 3%NaCl with guidance of endocrinology/nephrology In HF use loop diuretics and salt & water restriction hypertonic saline may worsen the situation. In SIADH use 3%NaCl for severe symptomatic cases, 0.9NaCl may not be helpful, Tolvaptan 15mg OD Measure serum Na every 4-6hrs,
Osmotic Demyelination Syndrome(ODS) This disorder is encountered more often after rapid correction of chronic hyponatremia rather than acute hyponatremia. Do not increase serum sodium by more than 6-8 mEq/24 h Quick correction especially >12 mEq/ 24 h might lead to osmotic demyelination syndrome (ODS). Risk factors for ODS include sodium level <120 mEq/l, alcoholism, liver disease and malnutrition.
It is a rare but serious condition that occur 2-6 days after rapid correction of sodium. It manifests with dysarthria, dysphagia, behavioral disturbances, paraplegia or quadriplegia, coma and seizures. The diagnosis is made with MRI. Upto 60% may recover their functional indepence, 7% mortality

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Approach to Hyponatremia, diagnosis and treatment.pptx

  • 2. Definition Serum Na+ <135mmol/L Affects upto 30% patients
  • 4. Hormone in fluid balance ADH/Vasopressin stimulated by increased tonicity(3rd ventricle/hypotholamus) or reduced intravascular volume. ADH increases water reabsorption, Vasopressin receptor 2, in nephron, insertion of aquaporin in apical membrane of the collecting duct. Cortisol Thyroid hormone
  • 6. SIADH Commonest cause of euvolemic hyponatremia Diagnosis of exclusion Normal response to hypoNa excretion of dilute urine SIADH reverse occurs hypertonic urine, raised urine sodium
  • 8. Steps to diagnosis Step 1: Determine Tonicity Hypotonic, hypertonic, isotonic
  • 10. Step 2: Clinical situation and fluid status Euvolemic, Hypovolemic and Hypervolemic
  • 12. Step 3: Urine Osmolality
  • 13. Step 4: Urine Sodium
  • 14. Step 5: Any other causes
  • 16. Treatment Prevention is key Stop culprit medication: thiazide, SSRI Correct to 125mmol/l Slow Correction is the way to go In hypovolemia fluid correction with 0.9NaCl, Replace K as well Symptomatic severe hyponatremia correct with 3%NaCl with guidance of endocrinology/nephrology In HF use loop diuretics and salt & water restriction hypertonic saline may worsen the situation. In SIADH use 3%NaCl for severe symptomatic cases, 0.9NaCl may not be helpful, Tolvaptan 15mg OD Measure serum Na every 4-6hrs,
  • 17. Osmotic Demyelination Syndrome(ODS) This disorder is encountered more often after rapid correction of chronic hyponatremia rather than acute hyponatremia. Do not increase serum sodium by more than 6-8 mEq/24 h Quick correction especially >12 mEq/ 24 h might lead to osmotic demyelination syndrome (ODS). Risk factors for ODS include sodium level <120 mEq/l, alcoholism, liver disease and malnutrition.
  • 18. It is a rare but serious condition that occur 2-6 days after rapid correction of sodium. It manifests with dysarthria, dysphagia, behavioral disturbances, paraplegia or quadriplegia, coma and seizures. The diagnosis is made with MRI. Upto 60% may recover their functional indepence, 7% mortality