hyponatremia and hyperglycemia: quick hits, quick math

30 Jul

 

Symptoms (VAGUE, NON-SPECIFIC) include:

  • nausea, vomiting,
  • anorexia,
  • muscle cramping,
  • lethargy,
  • confusion,
  • eventually seizure/coma/death

 

1st step is to determine the ECF volume status.

 

Hypertonic hyponatremiamost commonly hyperglycemia, each 100 mg/dL reduces serum Na by 1.7mEq/L

  • quick guesstimation/rule of thumb: add 1 to the sodium level for every 50 mg/dL glucose over 100
    • e.g. glucose 200, sodium 140 -> add 2 to 140 -> corrected Na~=142
    • e.g. glucose 500, sodium 140 -> add 8 to 140 -> corrected Na~=148
  • quick internet cheat: mdcalc’s Sodium Correction for Hyperglycemia

 

———————————-

30 seconds of the other stuff….

 

Isotonic hyponatremia—often referred to as factitious and does not require treatment.

 

Hypotonic Hyponatermia—Results from intracellular volume expansion with derangement of cellular functions (e.g. SIADH)

  • Six criteria of SIADH 
    • 1. Hypotonic hyponatremia
    • 2. Innappropriately elevated elevated urine osms (>200)
    • 3. elevated urinary Na
    • 4. Clinical Euvolemia
    • 5. Normal adrenal, renal, cardiac, hepatic, and thyroid fxn
    • 6. Correctable with water restriction

 

Submitted by J. Stanton.

 

References: uptodate.com; mdcalc.com; picture

 

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