Question

Hyponatremia: 
Approach to investigation and treatment. 
 

Hint:

In treating hyponatremia, always monitor the rate of sodium correction carefully. A rapid increase in sodium levels can cause significant neurological complications.

Answer 1

Step 1: Initial Investigation.
To diagnose hyponatremia, initial tests include:
1. Serum sodium levels: Confirm the diagnosis.
2. Urine sodium concentration: Helps in distinguishing between renal and non-renal causes of hyponatremia.
3. Thyroid and adrenal function tests: Rule out endocrine causes of hyponatremia.

Step 2: Treatment Approach.
Treatment depends on the severity and cause:
1. Mild cases: Fluid restriction or oral sodium replacement.
2. Moderate cases: Intravenous (IV) sodium administration with careful monitoring.
3. Severe cases: Hypertonic saline (3% NaCl) may be used, especially in acute situations.

Step 3: Monitoring and Follow-up.
Continuous monitoring of serum sodium is required to avoid rapid correction, which can lead to central pontine myelinolysis. Treatment should be gradual to restore sodium levels safely.