Resident Report 1/4 -Less Salt Please

Teaching Pearls:

  • In the setting of normal renal and endocrine function, you can utilize your urine studies to help determine the etiology of Hyponatremia
  • If Urine osmolality is low, consider the following two etiologies:
    • Primary polydipsia
      • Clinical history becomes important to differentiate.
    • Low solute diet (tea toast diet, beer potomania)
      • Clinical history becomes important to differentiate.
  • If urine osmolality is high, this suggests an abnormal feature as kidneys would normally increase free water excretion.
    • Check urine sodium. If high, consider:
      • medication use (SSRI), hypothyroidism, adrenal insufficiency, siADH (if others ruled out).
    • If low, then renal perfusion appears to be poor. This can be seen in some of the following conditions:
      • True hypovolemia
      • Hypervolemic states including CHF (cardiorenal syndrome), cirrhosis, etc

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