There may be other osmotically active solutes that cause hypertonic hyponatremia but I can’t think of any. (Please @ me if you have one)pic.twitter.com/Hd0uLS2uPc
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So that leaves the actual diagnosis, the patient had hyponatremia with an excess of an osmotically inactive solute. This can be seen with ethanol or BUN (kidney failure) (BUN).
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Since ethanol and BUN diffuse across the cell membrane (they osmotically inactive) they do not cause water to move out of the cell (the hall mark of true hypotonic hyponatremia).
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Joel Topf, MD FACP Retweeted Joel Topf, MD FACP
The elevated osmolality is also not the cause of the hypontremia and the hyponatremia still has to be diagnosed and treated in the usual way. The best article on this ishttps://twitter.com/kidney_boy/status/1092595492108812288?s=21 …
Joel Topf, MD FACP added,
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So we explained the elevated osmolality, but that doesn't explain the hyponatremia which still needs to be diagnosed and treated. This is different from hyponatremia with elevated osmolality from an osmotically active solute, where you should focus on treating the hyperosmolality
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Looking at the labs what do you think the diagnosis is? Serum osmolality 303 Urine osmolality 103 Urine Na < 20 Urine K 6
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Look at the urine osmolality. It is low Look to the ADH independent causes of hyponatremia.pic.twitter.com/cn1uQX0K8B
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This was the diagnosis. The patient had been on a beer only bender for weeks and had no essentially no other nutrition. Fin.
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Replying to @kidney_boy
Great tweetorial. I have a hate-love relationship with hypoNa. Don't think I've ever ordered uric acid for HypoNa workup- do you find this particularly helpful? Off-topic but I've always wondered- why do some hypovolemic patients develop hypoNa without AKI and vice versa?
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Replying to @grepmeded
Because the key factor in hypovolemic hyponatremia is increased ADH reducing the volume of urine so that water intake > water output. No need for AKI as long as ADH is lowering urine output.
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Thanks- intuitively that makes sense I guess what surprises me is the profound hypoNa we sometimes see without AKI versus others seem to bump their Cr immediately without the same compensation.
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