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Hypervolemic Hypoosmolar Hyponatremia

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Hypervolemic Hypoosmolar Hyponatremia

  • See Also
  1. Hyponatremia
  2. Hyperosmolar Hyponatremia
  3. Normoosmolar Hyponatremia
  4. Hypoosmolar Hyponatremia
  5. Hypovolemic Hypoosmolar Hyponatremia
  6. Isovolemic Hypoosmolar Hyponatremia
  7. Hyponatremia Management
  8. Sodium and Water Homeostasis
  • Pathophysiology
  1. Edematous State reduces effective circulating volume
  2. Decreased flow to nephron diluting segment
  3. Stimulates ADH release
  • Causes
  1. Urine Sodium < 10-15 meq/L (if no Diuretic use)
    1. Urine Osmolality >350 mOsm/kg water
    2. Edematous States
      1. Cirrhosis
      2. Congestive Heart Failure
      3. Nephrotic Syndrome
      4. Hypoalbuminemia
  2. Urine Sodium > 20 meq/L
    1. Advanced Renal Insufficiency
      1. Acute Kidney Injury
      2. Chronic Kidney Disease
  • Diagnostics (consider)
  1. Chest XRay
  2. Electrocardiogram
  3. Echocardiogram
  4. IVC Ultrasound for Volume Status
    1. Ultrasound may also demonstrate Ascites in Cirrhosis
  • Labs
  1. Urinalysis
  2. Urine Protein to Creatinine Ratio
  3. Comprehensive metabolic panel (Renal Function tests, Liver Function Tests)
  4. Brain Natriuretic Peptide (BNP)
  • Management
  1. See Hyponatremia Management
  2. Congestive Heart Failure
    1. Salt Restriction <2 to 3 grams/day
    2. Water restriction <1 Liter per day
    3. Decrease contributing Diuretics
    4. Optimize Cardiac Output
  3. Cirrhosis
    1. Water restriction <750 ml per day
    2. Loop Diuretics may be used cautiously in mild Hyponatremia (avoid in moderate to severe Hyponatremia)
  4. Severe Renal Insufficiency
    1. Consider Hemodialysis
  • References
  1. Kone in Tisher (1993) Nephrology, p. 87-100
  2. Levinsky in Wilson (1991) Harrison's IM, p. 281-84
  3. Rose (1989) Acid-Base and Electrolytes, p. 601-38
  4. Braun (2015) Am Fam Physician 91(5): 299-307 [PubMed]
  5. Miller (2023) Am Fam Physician 108(5): 476-86 [PubMed]