Hypervolemic Hypoosmolar Hyponatremia

Aka: Hypervolemic Hypoosmolar Hyponatremia

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II. Pathophysiology

  1. Edematous State reduces effective circulating volume
  2. Decreased flow to nephron diluting segment
  3. Stimulates ADH release

III. 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. Cirrhosis
      2. Congestive Heart Failure
      3. Nephrotic Syndrome
  2. Advanced Renal Insufficiency
    1. Urine Sodium > 20 meq/L

IV. Diagnostics (consider)

  1. Chest XRay
  2. Electrocardiogram
  3. Echocardiogram
  4. IVC Ultrasound for Volume Status
    1. Ultrasound may also demonstrate Ascites in Cirrhosis

V. Labs

  1. Urinalysis
  2. Urine Protein to Creatinine Ratio
  3. Comprehensive metabolic panel (Renal Function tests, Liver Function Tests)
  4. Brain Natriuretic Peptide

VI. Management

  1. See Hyponatremia Management
  2. Salt and water restriction
  3. Optimize Cardiac Output
  4. Consider Dialysis for Renal Insufficiency
  5. Consider Diuretics

VII. 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]

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