![]() ![]() Third spacing (e.g., bowel obstruction, burns)ģ,4-methylenedioxymeth-amphetamine (“Ecstasy”) useĮxcessive alcohol consumption, low serum osmolality Urinary osmolar gap, increased urinary pH, urinary sodium > 25 mEq per L, fractional excretion of bicarbonate > 15% to 20%, hyperchloremic acidosis, decreased serum bicarbonate level, potassium abnormalities (type dependent) Gastrointestinal loss (e.g., diarrhea, vomiting)Ĭlinical urinary sodium 20 mEq per L, positive results on cosyntropin stimulation test, 21-hydroxylase autoantibodies (Addison disease), computed tomography of adrenal glands to rule out infarction Serum and urinary monoclonal protein, bone marrow biopsy, lytic bone lesions detected on radiographyĭiagnosis of exclusion (e.g., head injuries, intracranial hemorrhage) urinary sodium > 20 mEq per L Hyperproteinemia (e.g., in multiple myeloma) Insulin, intravenous fluids, isotonic salineĮlevated total and low-density lipoprotein cholesterol levels Hyperglycemia (e.g., in diabetic ketoacidosis)Įlevated glucose levels (> 400 mg per dL ), elevated anion gap The treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit. Medications such as vaptans may have a role in the treatment of euvolemic and hypervolemic hyponatremia. Hypertonic saline is used to treat severe symptomatic hyponatremia. A combination of these therapies may be needed based on the presentation. In general, hyponatremia is treated with fluid restriction (in the setting of euvolemia), isotonic saline (in hypovolemia), and diuresis (in hypervolemia). Treatment is based on symptoms and underlying causes. Sodium disorders are diagnosed by findings from the history, physical examination, laboratory studies, and evaluation of volume status. Hyponatremia and hypernatremia are classified based on volume status (hypovolemia, euvolemia, and hypervolemia). Plasma osmolality plays a critical role in the pathophysiology and treatment of sodium disorders. Sodium disorders are associated with an increased risk of morbidity and mortality. Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings.
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