Nephrology Book

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Hypervolemic Hypoosmolar Hyponatremia

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  1. See Also
    1. Hypoosmolar Hyponatremia
  2. Pathophysiology
    1. Edematous state reduces effective circulating volume
    2. Decreased flow to nephron diluting segment
    3. Stimulates ADH release
  3. Causes
    1. Edematous States
      1. Urine Sodium < 10-15 meq/L (if no Diuretic use)
      2. Urine Osmolality >350 mOsm/kg water
      3. Conditions
        1. Liver disease
        2. Congestive Heart Failure
        3. Nephrotic Syndrome
    2. Advanced renal insufficiency
      1. Urine Sodium > 20 meq/L
  4. Evaluation: Diagnostics to consider
    1. Chest XRay
    2. Electrocardiogram
    3. Urinalysis
    4. Urine Protein to Creatinine Ratio
    5. Liver Function Tests
    6. Brain Natriuretic Peptide
  5. Management
    1. See Hyponatremia Management
    2. Salt and water restriction
    3. Optimize cardiac output
    4. Consider dialysis for renal insufficiency
    5. Consider Diuretics
  6. 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

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