The Diagnostic Approach to Hyponatremia
The Diagnostic Approach to Hyponatremia - Flowchart
«Flowchart»

Assessment of volume status

Assessment of volume status

Assessment of volume status

End

End

End

Hypovolemia


Total body water
Total body sodium

Hypovolemia


Total body water
Total body sodium


Total body water
Total body sodium Hypovolemia

Euvolemia (no edema)


Total body water
Total body sodium !!LtArrow!!!!RtArrow!!

Euvolemia (no edema)


Total body water
Total body sodium !!LtArrow!!!!RtArrow!!


Total body water
Total body sodium !!LtArrow!!!!RtArrow!! Euvolemia

Hypervolemia


Total body water
Total body sodium

Hypervolemia


Total body water
Total body sodium


Total body water
Total body sodium Hypervolemia

UNa >20

UNa >20

UNa >20

Na

Glucocorticoid deficiency
Hypothyroidism
Stress
Drugs
Syndrome of inappropriate antidiuretic hormone secretion

Glucocorticoid deficiency
Hypothyroidism
Stress
Drugs
Syndrome of inappropriate antidiuretic hormone secretion

Glucocorticoid deficiency
Hypothyroidism
Stress
Drugs
Syndrome of inappropriate antidiuretic hormone secretion





Nephrotic syndrome
Cirrhosis
Cardiac failure

Nephrotic syndrome
Cirrhosis
Cardiac failure

Nephrotic syndrome
Cirrhosis
Cardiac failure



Acute or chronic renal failure

Acute or chronic renal failure

Acute or chronic renal failure

UNa >20

UNa >20

Na U(Na) >20

UNa <20

UNa <20

Na U(Na) <20

Renal losses
Diuretic excess
Mineral corticoid deficiency
Salt-losing deficiency
Bicarbonaturia with renal tubal acidosis and metabolic alkalosis
Ketonuria
Osmotic diuresis
Cerebral salt wasting syndrome

Renal losses
Diuretic excess
Mineral corticoid deficiency
Salt-losing deficiency
Bicarbonaturia with renal tubal acidosis and metabolic alkalosis
Ketonuria
Osmotic diuresis
Cerebral salt wasting syndrome

Renal losses
Diuretic excess
Mineral corticoid deficiency
Salt-losing deficiency
Bicarbonaturia with renal tubal acidosis and metabolic alkalosis
Ketonuria
Osmotic diuresis
Cerebral salt wasting syndrome








Extrarenal losses
Vomiting
Diarrhea
Third spacing of fluids
Burns
Pancreatitis
Trauma

Extrarenal losses
Vomiting
Diarrhea
Third spacing of fluids
Burns
Pancreatitis
Trauma

Extrarenal losses
Vomiting
Diarrhea
Third spacing of fluids
Burns
Pancreatitis
Trauma







UNa >20

UNa >20

Na U(Na) <20

UNa <20

UNa <20

Na U(Na) <20