Pathogenesis (development of disease) Forms of hyponatremia: Hypertonic hyponatremia: in the presence of increased concentrations of other osmotically effective substances, usually glucose. The osmotic gap is greater than 10 mosmol/L. Hyponatremia in polydipsia (excessive thirst). Hyponatremia in euvolemia (total body sodium in the normal range). Urine Na+ > 30 mmol/L Syndrome of inadequate ADH secretion … Sodium Deficiency (Hyponatremia): Causes
General measures Review of permanent medication due topossible effect on existing disease. Renunciation of drug use – Ecstasy (also XTC and others) – amphetamine derivative; collective name for a variety of phenylethylamines. Nutritional medicine Nutritional counseling based on nutritional analysis Nutritional recommendations according to a mixed diet taking into account the disease at hand. This … Sodium Deficiency (Hyponatremia): Therapy
The following symptoms and complaints may indicate hyponatremia (sodium deficiency): Edema (water retention) [hyponatremia in hypervolemia, e.g., heart failure (cardiac insufficiency), liver cirrhosis (irreversible damage to the liver leading to gradual connective tissue remodeling of the liver with impairment of liver function), nephrotic syndrome] Moderately severe symptoms: Nausea (sickness) without vomiting. Cephalgia (headache) Gait unsteadiness … Sodium Deficiency (Hyponatremia): Symptoms, Complaints, Signs
Medical history (history of illness) represents an important component in the diagnosis of hyponatremia (sodium deficiency). Family history Do family members (e.g., parents/grandparents) have metabolic diseases? Social history What is your profession? Current medical history/systemic history (somatic and psychological complaints). Do you suffer from nausea? Have you been vomiting? Do you have a headache? Is … Sodium Deficiency (Hyponatremia): Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Hypercorticism (Cushing’s disease: hypercortisolism; excess of cortisol). Hypothyroidism (hypothyroidism). Addison’s disease (primary adrenocortical insufficiency) – 84% of patients had serum sodium <137 mmol/l at the time of diagnosis Adrenocortical insufficiency (NNR insufficiency; adrenocortical insufficiency). Syndrome of inadequate ADH secretion (SIADH) (synonym: Schwartz-Bartter syndrome) – there is an inappropriately high … Sodium Deficiency (Hyponatremia): Or something else? Differential Diagnosis
The following are the major diseases or complications that may be contributed to by hyponatremia (sodium deficiency): Endocrine, nutritional, and metabolic diseases (E00-E90). Cephalgia (headache) Serum hypoosmolarity – lowered osmotic pressure in the blood. Volume deficiency Psyche – nervous system (F00-F99; G00-G99) Delir Vomiting Epilepsy (seizures) Brain edema (swelling of the brain) Lethargy (sleep addiction) … Sodium Deficiency (Hyponatremia): Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin, mucous membranes, and sclerae (white part of the eye) [edema/water retention]. Auscultation (listening) of the heart. Examination of the lungs Auscultation (listening) of the lungs [tachypnea (> 20 … Sodium Deficiency (Hyponatremia): Examination
Laboratory parameters of the 1st order – obligatory laboratory tests. Small blood count Electrolytes – potassium, sodium [hyponatremia: < 135 mmol/l] Urine sodium in spontaneous urine. Total protein in serum (serum protein; serum protein). Urinary and serum osmolality (U-osm, H-osm). Glucose Urea Laboratory parameters 2nd order – depending on the results of the history, physical … Sodium Deficiency (Hyponatremia): Test and Diagnosis
Therapeutic targets Correction of the sodium balance Rehydration (fluid balance), as necessary. Therapy recommendations As far as a causal cause is present: Co-treatment of the causative disease (e.g. hypothyroidism/ hypothyroidism). Hyponatremia in hypovolemia: correction of volume depletion (water loss) with NaCl (0.9%) i. v. Hyponatremia in euvolemia: Mild clinical cases: Fluid restriction (≤ 1 L/d). … Sodium Deficiency (Hyponatremia): Drug Therapy
Mandatory medical device diagnostics. Blood pressure measurement Abdominal ultrasonography (ultrasound examination of the abdominal organs) – for basic diagnostics.
To prevent hyponatremia (sodium deficiency), attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Increased fluid intake (water intoxication). Inadequate intake of sodium and table salt. Micronutrient deficiency (vital substances) – sodium Consumption of stimulants Alcohol (in this case, elderly people with long-term malnutrition + more than five liters of beer … Sodium Deficiency (Hyponatremia): Prevention
