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The history and physical exam are necessary to help determine if the person is hypovolemic, euvolemic, or hypervolemic, which has important implications in determining the underlying cause. An assessment is also made to determine if the person is experiencing symptoms from their hyponatremia.
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.
Treatment choice depends on the type of hyponatremia. [2] Traditional treatment for hyponatremia depends on the volume load in the person. For those who are euvolemic (normal body volume load), fluid intake should be restricted. In those that are hypovolemic (low body volume load), give isotonic saline.
The most common cause of hypovolemia is diarrhea or vomiting. The other causes are usually divided into renal and extrarenal causes. Renal causes include overuse of diuretics, or trauma or disease of the kidney. Extrarenal causes include bleeding, burns, and any causes of edema (e.g. congestive heart failure, liver failure).
However, not every person with hyponatremia and elevated ADH has SIADH. One approach to a diagnosis is to divide ADH release into appropriate (not SIADH) or inappropriate (SIADH). Appropriate ADH release can be a result of hypovolemia, a so-called non-osmotic trigger of ADH release.
These electrolytes must be replaced to keep the electrolyte concentrations of the body fluids constant. Hyponatremia, or low sodium, is the most commonly seen type of electrolyte imbalance. [12] [13] Treatment of electrolyte imbalance depends on the specific electrolyte involved and whether the levels are too high or too low. [3]
Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. [1] This may be due to either a loss of both salt and water or a decrease in blood volume. [2] [3] Hypovolemia refers to the loss of extracellular fluid and should not be confused with dehydration. [4]
Euvolemia is the state of normal body fluid volume, including blood volume, interstitial fluid volume, and intracellular fluid volume; hypovolemia and hypervolemia are imbalances. Water is necessary for all life on Earth. Humans can survive for 4 to 6 weeks without food but only for a few days without water.