**Hyponatremia <136 mEq

(Suspect in elderly with AMS, seizure or frequent falls) www.reviewsinem.com

1: Calculate Serum Osm

Estimate by:
Osm = 2xNa + BUN/1.8 + Glucose/28

Hypertonic (>300) Isotonic 275-300

2: Hypotonic " True" Hyponatremia

Osm <275
Caused by mannitol Caused by Increase
hyperglycemia, or Triglycerides, or
contrast proteins (myeloma)

No
Severe Symptoms Yes Treatment of Severe Symptoms:
1. Severe symptoms = seizure, herniation or encephalopathy
2. Give: 150ml (3ml/kg) of 3% hypertonic saline over 20 min
3: Calculate Urine 3. Goal: Raise Serum Na by 5 mEq/L to stop symptoms
Osmolality from UA spec 4. Check serum Na 20 min after infusion of 3%
grav:
UOsm = (1 - SG) x 25000
3a: UOsm <100
3b: UOsm>100
mOsm/kg
mOsm/kg
(Also Feurate 4-11%)

BOX 1
Primary Polydipsia Additional Labs Needed:
Low Sodium Plasma: cortisol, Osmoles, TSH, Uric
intake acid
Beer Potomania Urine: Uric Acid, Na, K, Creatinine
4. U Na <30 6. U Na>30 meq/L 8. Measure FEurate
meq/L

BOX 5
Euvolemic, FEUrate
7. Volume Status
>11%
5. Volume Status BOX 4 SIADH
HypOvolemic Or Hypothyroidism
FEurate <4% Cushing
Vomiting
Addison's
BOX 2 Salt wasting 8. Recheck
HypERvolemic BOX 3 FEurate When
OR FEurate <4% HypOvolemic Or Serum Na >130
CHF FENa <0.1%
Cirrhosis V/D BOX 6
Third Spacing FEurate<11% BOX 7
Nephrotic Syndrome
SIADH FEurate >11%
Diuretics
HCTZ Salt Wasting

** WARNING: The information contained herein should not be taken as medical advice. This information is strictly for experienced See associated r efer ences and discussion
practicing clinicians and should only be used by those experienced in the care of Hyponatremia. infor mation