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Hyponatremia

Caitlin E. Jones, MD, Patricia Martinez Quinones, MD and Cassandra Q. White, MD, FACS Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Hyponatremia is a plasma sodium (Na+) concentration of ≤135 mEq/L.

  • Hyponatremia itself does not provide information about the “total body water (TBW)” state of the patient. Patients w...

DIAGNOSIS

  • Symptoms related to the rate of fall in serum Na+, onset and degree of hyponatremia (2)

  • Acute (≤48 hours): no time for full adaptation, more likely to present with moderate or severe symptoms

  • ...

TREATMENT

GENERAL MEASURES

  • Assess all medications patient is taking.

  • Institute seizure precautions.

  • Institute fluid restriction.

  • Indications for 3% hypertonic saline versus normal saline solution: acute h...

ONGOING CARE

DIET

  • Euvolemic hyponatremia: Restrict water to 1 L/day.

  • Hypervolemic hyponatremia: water and Na+ restriction

PROGNOSIS

  • In hospitalized patients, hyponatremia is associated with an elevated ri...

REFERENCES

1
Rondon-Berrios H, Agaba EI, Tzamaloukas AH. Hyponatremia: pathophysiology, classification, manifestations and management. Int Urol Nephrol.  2014;46(11):2153–2165. [View Abstract on O...

ADDITIONAL READING

  • Abraham WT, Hensen J, Gross PA, et al; for LIBRA Study Group. Lixivaptan safely and effectively corrects serum sodium concentrations in hospitalized patients with euvolemic hyponatr...

CODES

ICD10

E87.1 Hypo-osmolality and hyponatremia 

ICD9

276.1 Hyposmolality and/or hyponatremia 

SNOMED

  • 89627008 Hyponatremia (disorder)

  • 267447008 Hypo-osmolality and or hyponatremia

  • 74185008 Hyponatremia w...

CLINICAL PEARLS

  • Assess all medications patient is taking because many are associated with hyponatremia.

  • Alcohol-dependent individuals with vitamin deficiencies, elderly women taking thiazide diuretics,...

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