DIAGNOSIS

Hyponatremia should be considered whenever there is a

sudden deterioration in CNS function, particularly in circumstances such as
o intractable heart failure,
o hepatic cirrhosis with ascites, or
o when large volumes of intravenous fluids are administered.
This evaluation should include a careful history and physical examination; measurement of the serum
creatinine, BUN, and electrolyte levels; measurement of the urinary sodium concentration, or the
fractional excretion of sodium; measurement of serum and urinary osmolalities; and, when appropriate,
evaluation of thyroid and adrenal function.
The history and physical examination are generally adequate for recognizing disorders such as
o beer potomania or
o compulsive water
o for noting the ingestion of drugs that stimulate ADH release or enhance ADH action.
The presence of edema is characteristic of individuals in whom hyponatremia occurs because of a reduced
effective arterial blood volume coupled to ECF volume expansion.
The most difficult differential diagnosis among hyponatremic disorders involves the distinction between
patients who are modestly volume contracted and those who have SIADH.
In both circumstances, the serum sodium and the serum osmolality are reduced, whereas the urinary
osmolality is inappropriately high with respect to the reduced serum osmolality.
Patients with SIADH are generally normovolemic or slightly volume expanded and therefore exhibit none
of the signs of volume contraction.