Sodium

Hypervolemic Hypoosmolar Hyponatremia

search

Hypervolemic Hypoosmolar Hyponatremia

  • Pathophysiology
  1. Edematous state reduces effective circulating volume
  2. Decreased flow to nephron diluting segment
  3. Stimulates ADH release
  • Causes
  1. Edematous States
    1. Urine Sodium < 10-15 meq/L (if no Diuretic use)
    2. Urine Osmolality >350 mOsm/kg water
    3. Conditions
      1. Cirrhosis
      2. Congestive Heart Failure
      3. Nephrotic Syndrome
  2. Advanced Renal Insufficiency
    1. Urine Sodium > 20 meq/L
  • Management
  1. See Hyponatremia Management
  2. Salt and water restriction
  3. Optimize Cardiac Output
  4. Consider Dialysis for Renal Insufficiency
  5. Consider Diuretics
  • References
  1. Kone in Tisher (1993) Nephrology, p. 87-100
  2. Levinsky in Wilson (1991) Harrison's IM, p. 281-84
  3. Rose (1989) Acid-Base and Electrolytes, p. 601-38
  4. Braun (2015) Am Fam Physician 91(5): 299-307 [PubMed]