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Hypoosmolar hyponatremia is a condition where hyponatremia is associated with a low plasma osmolality. [1] The term "hypotonic hyponatremia" is also sometimes used.[2]When the plasma osmolarity is low, the extracellular fluid volume status may be in one of three states: low volume, normal volume, or high volume.
The causes of hyponatremia are typically classified by a person's body fluid status into low volume, normal volume, or high volume. [4] Low volume hyponatremia can occur from diarrhea, vomiting, diuretics, and sweating. [4] Normal volume hyponatremia is divided into cases with dilute urine and concentrated urine. [4]
Patients with extra-renal salt losses complicated by hyponatremia were found to be common-place, and consistent with McCance's description, they excreted urine virtually free of sodium. [22] In 1950, Sims et al, published their work that suggest observed relation between hyponatremia and pulmonary tuberculosis.
Almost a century after the pioneering work of Bernard in animals, Peters et al., in 1950, reported three patients seen at Yale New Haven Hospital with hyponatremia associated with varying cerebral pathologies and severe dehydration. In each patient, urine sodium losses persisted despite hyponatremia and a high-salt diet.
In general, hyponatremia is usually asymptomatic until severe. [10] Typical laboratory findings for tea and toast syndrome include a low serum osmolality (hypotonicity) with normal urine osmolality since antidiuretic hormone levels are normal. A common laboratory finding for the tea and toast phenomenon is manifestation as hyponatremia.
Urine osmolality in humans can range from approximately 50 to 1200 mOsm/kg, depending on whether the person has recently drunk a large quantity of water (the lower number) or has gone without water for a long time (the higher number). [2] Plasma osmolality with typical fluid intake often averages approximately 290 mOsm/kg H 2 O in humans. [2]
Urine sodium is a measurement of the concentration of sodium in the urine. It is a test ordered to distinguish between forms of renal failure and to classify the severity of hyponatremia. [1] The urine sodium is expressed as a concentration (such as millimoles per liter).
[14] [3] Dilutional hyponatremia can happen in diabetics as high glucose levels pull water into the blood stream causing the sodium concentration to be lower. [14] [3] Diagnosis of the cause of hyponatremia relies on three factors: volume status, plasma osmolality, urine sodium levels and urine osmolality. [14] [3]