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55 Hyponatremia

 

439

 

 

Table 55.2 Differentiating SIADH from CSW

 

 

CSW

SIADH

Plasma volume

Decreased

Normal or increased

Salt balance

Negative

Normal

H2O balance

Negative

Increased or no change

Signs of dehydration

Present

Absent

Weight

Decreased

Increased or no change

PCWP and CVP

Decreased

Increased or normal

Hematocrit

Increased

Increased or normal

BUN/creatinine ratio

Increased

Normal

Serum protein concentration

Increased

Normal

Serum K concentration

Increased or no change

Decreased or no change

Serum uric acid concentration

Normal

Decreased

PCWP pulmonary capillary wedge pressure, CVP central venous pressure, BUN blood urea nitrogen

¥Normal serum uric acid.

¥Increased fractional excretion of urate.

¥This can be differentiated from SIADH as mentioned in Table 55.2.

Management

¥Treat the underlying causes of CSW like subarachnoid hemorrhage.

¥Put the central line to assess volume status.

¥Volume replacementÑmatch urine loss.

¥ Amount of sodium required = sodium deÞcit × total body water (See step 8). ¥ Blood product if anemia is present.

Step 12: Hyperosmolar hyponatremia

Consider hypertonic mannitol or other osmotic agents and hyperglycemia.

¥Stop infusion.

¥HyperglycemiaÑstop or decrease glucose administration.

¥Give insulin and ßuids.

¥Target a drop in glucose concentration of 75Ð100 mg/dL/h.

Step 13: Iso-osmolar hyponatremia

Consider pseudohyponatremia (drip arm sample, hyperlipidemia, paraproteinemia); usually asymptomatic and no treatment is required.

Suggested Reading

1.Ferguson-Myrthil N. Novel agents for the treatment of hyponatremia: a review of conivaptan and tolvaptan cardiology in review. Cardiol Rev. 2010;18(6):313Ð21.

The article describes the role of conivaptan and tolvaptan in the treatment of hyponatremia.

2.Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med. 2007;120(11A):S1ÐS21.

A comprehensive guideline-based approach for the management of hyponatremia.

440

R. Chawla et al.

 

 

3.Irwin RS, Rippe JM. Irwin and RippeÕs intensive care medicine. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 898Ð912.

4.Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342:1581Ð9.

Pictorial description of extracellular fluid and intracellular fluid compartments under normal conditions and during states of hyponatremia.

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