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Renal - Hyponatremia

ACP Nephrology p11

Formula for total osmolality 2 x Serum sodium + plasma glucose / 18 + BUN / 2.8
Does urea exert an osmotic effect? No because it is freely diffusible across most cell membranes
What is normal osmolality 280-285 (or 275 - 295)
What is the function of ADH? Promotes water reabsorption in the distal tubule and collecting duct of the kidney (causes fluid retention). Also has a peripheral vasoconstriction effect.
Serum sodium under which a patient is considered to have hyponatremia 135
First step in assessing hyponatremia Serum sodium less than or equal to 135
Second step in assessing hyponatremia Is the patient symptomatic?
What are mild symptoms of hyponatremia? Headache, lethargy, dizziness
What are symptoms of severe hyponatremia? confusion, ataxia, seizures, obtundation, coma, respiratory depression
If a patient with hyponatremia is asymptomatic or has mild symptoms, then what is the next step? Assess serum osmolality. Hypotonic hyponatremia is osmolality < 280. Isotonic hyponatremia is osmolality 280-285. Hypertonic hyponatremia's osmolality > 285.
What is the differential for isotonic hyponatremia? Hyperproteinemia or hyperlipidemia
What is the differential for hypertonic hyponatremia? Hyperglycemia, mannitol, sorbitol, contrast
Created by: christinapham
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