#Hypervolemic Hyponatremia, moderate, chronic, etiology unknown
DDx of hypervolemic hyponatremia: CHF, Cirrhosis, nephrotic syndrome, or advanced renal failure.
ABCs – pt stable. No severe symptoms like seizures, obtundation, coma, and respiratory arrest.
Pert +/- hx:
No hx of polydipsia, excessive alcohol intake (beer potomania unlikely) or Low solute:“tea & toast”. No common SIADH causes such as malignancy, pulmonary disease, intracranial process, and drugs like antipsychotics, antidepressants, chemotherapy, etc. No hyperglycemia or history of mannitol or sorbitol use or recent administration of radiocontrast media.
No hx of renal losses or extrarenal losses (which are common causes of hypovolemic hypotonic hyponatremia)
Pert +/- PE: Volume status is hypervolemic (Based on PE & evaluating of vital signs, orthostatic vitals, evaluating for JVP, skin turgor, mucous membranes, peripheral edema, BUN, Cr. Uric acid not drawn.)
Pert +/- Labs:
Pert +/- Imaging/Studies:
Tx:
Free Water Restrict. And consider the following as needed:
Loop diuretics (avoid thiazides) to mobilize excess sodium and water.
Vasodilators to increase CO in CHF — this increases effective arterial volume (EAV).
Colloid infusion in cirrhosis — this also increases effective arterial volume (EAV).
F/u CMP, Serum Osmolality; Urine Osmolality, Urine Sodium; Urine creatinine. All five labs must be drawn at the same time.
F/u AM Cortisol, TSH, and free T4 if concerned about hypothyroidism and glucocorticoid deficiency as contributing causes.
Urinalysis; CXR
F/u daily BMP
F/u to calculate FENa
NPO for now.
Orthostatic VS every shift if diuretic is being used..
D/C meds that could contribute to hyponatremia (diuretics, NSAIDs, TCAs, antipsychotics, antiepileptics, SSRIs, theophylline, amiodarone)