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Isotonic hyponatremia is a form of hyponatremia with mOsm measured between 280 and 295. It can be associated with pseudohyponatremia, or with isotonic infusion of glucose or mannitol . [ 1 ]
Hyponatremia or hyponatraemia is a low concentration of sodium in the blood. [4] It is generally defined as a sodium concentration of less than 135 mmol/L (135 mEq/L), with severe hyponatremia being below 120 mEq/L. [3] [8] Symptoms can be absent, mild or severe.
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.
Moderate or severe hyponatremia, or hyponatremia with severe symptoms is treated by raising the serum sodium level by 1–2 mmol per liter per hour for the first few hours with a goal of raising levels less than 8–10 mmol per liter in the first 24 hours and 18 mmol per liter in the first 48 hours. [2]
[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]
Hyperglycemia or hyperglycaemia is a condition where unusually high amount of glucose is present in blood. It is defined as blood glucose level exceeding 6.9 mmol/L (125 mg/dL) after fasting for 8 hours and 10 mmol/L (180 mg/dL) 2 hours after eating. [1] [2]
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.
Diagnosis is often delayed since most of the symptoms of adrenal insufficiency are nonspecific and develop insidiously. [5] Hypotension and shock that fail to respond to vasopressors or fluid resuscitation are the main signs of an adrenal crisis. [6] Those in an adrenal crisis can deteriorate quickly, usually within a few hours. [7]