CRM2 - Hyponatremia & Hypernatremia

Hyponatremic (SNa < 135), Isotonic (Sosm = 280-295) + HLD + Hyperproteinemia

Dx = Pseudohyponatremia

Hyponatremic (SNa < 135), Hypotonic (Sosm < 280), Low UOsm (< 100)

Dxs = Hypotonic Hyponatremia due to Primary Polydipsia, Beer Potomania, Tea & Toast

Hyponatremic (SNa < 135), Hypotonic (Sosm < 280), Norm UOsm (>100), Sx = Dry mucous membranes, decreased skin turgor, flat jugular veins, OH; UNa > 20

Dx = Hypotonic Hypovol Hyponatremia due to Renal Salt Wasting --> Diuretic abuse, Mineralocorticoid deficiency

Hyponatremic (SNa < 135), Hypotonic (Sosm < 280), Norm UOsm (>100), Sx = Dry mucous membranes, decreased skin turgor, flat jugular veins AND Diarrhea/Vomiting/Sweat/Burns, OH; UNa < 20

Dx = Hypotonic Hypovol Hyponatremia due to Extra Renal Loss (kidneys trying to retain sodium)

Hyponatremic (SNa < 135), Hypotonic (Sosm < 280), Norm UOsm (> 100), Sx = Moist mucous membranes, normal skin turgor/jug veins, no edema

Dx = Hypotonic Euvol Hyponatremia due to SIADH (seen often w/ MDMA), Hypothyroid, Glucocort deficiency

Hyponatremic (SNa < 135), Hypotonic (Sosm < 280), Norm UOsm (> 100), Sx = Edema, crackles in lungs, Bulging Jugular Veins; UNa > 20

Dx = Hypotonic Hypervolemic Hyponatremia AKI/CKD (kidneys too damage to make dilute urine)

Hyponatremic (SNa < 135), Hypotonic (Sosm < 280), Norm UOsm (> 100), Sx = Edema, crackles in lungs, Bulging Jugular Veins; UNa < 20

Dx = Hypotonic Hypervolemic Hyponatremia due to HF, Cirrhosis, Nephrotic Syndrome (low EABV, despite high TBW)

Hyponatremic (SNa < 135), Hypertonic (Sosm > 295)

Dx = Hypertonic Hyponatremia (due to Hyperglycemia or Mannitol)

Hypernatremic (SNa > 145), Sx = Dry mucous membranes, decreased skin turgor, flat jugular veins; UNa > 20 and/or High UOsm (> 700)

Dx = Hypovol Hypernatremia due to Renal Loss (Diuretics, Glycosuria, Intrinsic Renal Disease)

Hypernatremic (SNa > 145), Sx = Dry mucous membranes, decreased skin turgor, flat jugular veins AND Diarrhea/Vomit/Sweat (seen often in elderly or immobile people w/o access to water); UNa < 20 and/or High UOsm (> 700)

Dx = Hypovol Hypernatremia due to Extra Renal Loss of Water (Dehydration)

Hypernatremic (SNa > 145), Sx = Moist mucous membranes, normal skin turgor/jugular veins, no edema; High UOsm (> 700)

Normal Kidney Function OR Hypovol Hypernatremia due to Extra Renal Loss of Water (Dehydration)

Hypernatremic (SNa > 145), Sx = Moist mucous membranes, normal skin turgor/jugular veins, no edema; Low UOsm (aka dilute) --> Positive DDVAP response (SNa & UOsm normalize)

Dx = Euvol Hypernatremia due to Central DI

Hypernatremic (SNa > 145), Sx = Moist mucous membranes, normal skin turgor/jugular veins, no edema; Low UOsm (aka dilute) --> Negative DDVAP response (SNa & UOsm don't change)

Dx = Euvol Hypernatremia due to Nephrogenic DI

Hypernatremic (SNa > 145), Sx = Edema, Crackles in Lungs, Bulging Jugular Veins; Recently taking NaCl tablets or on Hypertonic Saline

Dx = Hypervol Hypernatremia due to Iatrogenic Hypernatremia

Hypernatremic (SNa > 145), Sx = Edema, Crackles in Lungs, Bulging Jugular Veins; Sx of blurred vision, muscle weakness, headaches, fatigue, excessive thirst & polyuria

Dx = Hypervol Hypernatremia due to Primary Aldosteronism

Hypernatremic (SNa > 145), Sx = Edema, Crackles in Lungs, Bulging Jugular Veins; Sx of moon face, poorly healing wounds, HTN, excessive hair growth, D2M

Dx = Hypervol Hypernatremia due to Cushing's Syndrome