Question

Discuss the diagnosis and treatment of hyponatremia.

Hint:

Always correct hyponatremia slowly to prevent osmotic demyelination. The correction rate should generally not exceed 8-10 mmol/L per day.

Answer 1

Step 1: Diagnosis of hyponatremia.
The diagnosis of hyponatremia is confirmed through the following:
- Serum sodium levels: A serum sodium level below 135 mmol/L confirms hyponatremia.
- Urine osmolality: In cases of SIADH, urine osmolality will be high despite low sodium levels.
- Assessment of volume status: Determining if the patient is hypovolemic, euvolemic, or hypervolemic helps to identify the cause of hyponatremia.
- Clinical history and examination: Factors like recent fluid intake, medications, or underlying conditions (e.g., heart failure, kidney failure) are key in making a diagnosis.

Step 2: Treatment of hyponatremia.
The treatment depends on the severity and underlying cause:
- Mild hyponatremia: Restricting water intake and monitoring sodium levels.
- Moderate to severe hyponatremia: IV sodium correction (hypertonic saline) in a controlled manner to prevent complications like osmotic demyelination.
- Treatment of underlying causes: For example, stopping diuretics or treating SIADH with medications like vasopressin receptor antagonists (tolvaptan).

Step 3: Conclusion.
Hyponatremia requires careful diagnosis and treatment. It is essential to identify the cause and treat accordingly, either through fluid management, medication, or correction of electrolyte imbalances.