Remember to check plasma osmolality first!

Next evaluate volume status!

If a patient is Euvolemic – evaluate urine osmolality and sodium

Practical approach to hyponatremia:

1.What is the normal/abnormal physiology?

2.Is it “true” hypo-osmolar hyponatremia?

• Measure plasma osmolality

3.What is the volume and ADH status?

• Urine Na and Urine Osmolality

4.Is it symptomatic?

5.What is my treatment?

• Depends on volume status, ADH status, and +/- symptoms
• Determine goal of correction
• Avoid overcorrection