Hyponatremia
HISTORY:
Presents for hyponatremia
Lab results:
Na , K , Cl
BUN , creatinine , Albumin
Ca , Mg , Phosphate
Urinalysis
Osmolality
Associated symptoms: *Try using right-click for negatives*
Other elements:
EXAM:
General appearance:
Vital signs: , BP , HR , RR , SpO2 %, Temp °
Measurements: weight: kg, height: cm, waist: cm, BMI:
Neck:
Heart: ,
Lungs: ,
Abdomen: , , ,
Skin:
Extremities: , , cap refill , pulses ,
Neurologic: cranial nerves , strength , sensation , reflexes , cerebellar function , gait
ASSESSMENT:
DDx:
PLAN:
- Blood work: , , , , , , ,
- Urine: , ,
- ECG
- Chest X-ray
If hypervoemic:
- Fluid restriction to per day
-
-
If euvolemic:
- Fluid restriction to per day
- Stop offending medications
- NaCl 1g po BID
- Hypertonic saline 3% ml IV use with caution
If hypovolemic:
- Normal saline 0.9% ml IV if hypovolemic
- Natremia correction max 10 per 24h
- Increase dietary sodium
- Repeat Na in
- Referral to internist
- Referral to nephrologist
- Follow-up in
- Return if symptoms worsen or if new symptoms develop such as headache, nausea, or vomiting
- Go to ER if severe headache, confusion, seizures, or loss of consciousness occurs