Isotonic+Hyponatremia+

Key)Concepts:)

Pseudo )(hyperlipidemia,)
hyperproteinemia)
Isotonic)infusions)(glucose,)
glycerol,)mannitol,)sorbitol,)
glycine,)ethanol))

Osmolarity)equilibrates)across)all)
compartments)
NaCl)is)almost)exclusively)in)the)ECF)
Ineec've)osmoles )such)as)urea)
traverse)freely)across)cell)membranes)and)
therefore)do)not)move)water)
)

Intracelular)uid)
Na=)15)
K=))120)
Ca=10)
Mg=1)

Uosm)

>100)

SIADH)
Hypothyroidism)
Addison s)Disease)

Hypovolemic+

UNa>20)
Renal)Losses)
Diure'c)
Glycosuria)
Urea)diuresis)
Acute/Chronic)
Renal)Failure)

)
)
)

Forces OUT

Forces IN

(favor filtration)

(oppose filtration)

Kf [(Pcap + is)-(Pis + cap)]

Kf [ (24 + 5 )-(25 + 3.5 )]

<100)

Cirrhosis)
CHF)
Nephrosis)
Renal)Failure)

Polydipsia)

Hyperosmo'c)
Hypernatremia)

Inters''al)volume))))1/4)

Circula'ng)volume))))1/12)

Na=)145)
K=))4.5)
Ca=1.2)
Mg=.55)

Hypervolemic+

Euvolemic+

Dehydra'on)
Diure'cs)
Salt)was'ng)
(Renal)failure))
)
)

TBW=0.6(x(weight(in(kg(

Na=)142)
K=))4.4)
Ca=1.2)
Mg=0.6)

Hypoosmo'c)
Hyponatremia)

Hypovolemic+

Extracellular)uid)

Hypertonic+Hyponatremia+

Hyperglycemia)
Hypertonic)Infusions)(glucose,)
glycerol,)mannitol,)sorbitol,)glycine)

Hypervolemic+

Euvolemic+

UNa<10)
Extrarenal)Losses)
Swea'ng)
GI)
Respiratory)

)
)
)

UNa>20)

UNa)Variable)

Hypertonic)NaHCO3)
NaCL)tablets)
Hypertonic)IVF)
Hyperaldosteronism)
Hypertonic)dialysis)

Diabetes)insipidus)
Skin/resp)
Insensible)Losses)

Polyuria+(UO>3L/d)+
Normal

Edema Forming
State
(New Jersey)

Osmo5c+Diuresis+
NaCl)
Glucose)
Urea)
Mannitol)

)
)

Water+Diuresis+

SNa>140)
DI)

)
)
)

SNa>140)
Polydipsia)

PONTINE MYELINOLYSIS

=Na+
=K+
=Organic Osmolytes

Brain Cell

O
H2

Restoration of Normal Size

Hyponatremia

the cell pumps out electrolytes and

osmolytes to restore normal size over time

Shrunken Brain CellMyelinolysis

Rapid restoration of Na+ outside of the cell
leads to cell shrinkage. There is no time for the
cell to restore its osmolytes

Swollen Brain Cell

due to low osmolarity outside,
water shifts into cells

H2O

DISCLAIMER: All
characters and events in
this diagram, although
based in fact, are entirely
fictitious. Any resemblance
to real cells, living or dead,
is purely coincidental. No
actual brain cells were
injured for this presentation.