#Hypovolemic Hyponatremia, moderate and likely chronic, etiology unknown
ABCs – pt stable. No severe symptoms like seizures, obtundation, coma, and respiratory arrest.
Pert +/- hx: No hx of CHF, Cirrhosis, nephrotic syndrome, or advanced renal failure. 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.
Pert +/- PE: Volume status is hypovolemic after PE & evaluating of vital signs, orthostatic vitals, JVP, skin turgor, mucous membranes, peripheral edema, BUN, Cr. Uric acid not drawn.
Pert +/- Labs:
Pert +/- Imaging/Studies:
Tx: Volume repletion with normal saline. Once the volume is replete, the stimulus for ADH should be removed. The removal of ADH should cause the kidneys to excrete free water, which will lead to the rapid correction of serum sodium.
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
Urinalysis; CXR
F/u daily BMP
F/u to calculate FENa
NPO for now.
Orthostatic VS every 4 hrs until stable x4, then every shift.
D/C meds that could contribute to hyponatremia (diuretics, NSAIDs, TCAs, antipsychotics, antiepileptics, SSRIs, theophylline, amiodarone)
Consider lactate.