Hyponatremia Diagnosis and Symptoms
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Questions and Answers

What is the primary manifestation of hyponatremia when sodium levels decline rapidly or reach a level less than 125 mEq/L?

  • Daily urinary sodium excretion exceeds 20 mEq/L
  • Focal neurologic abnormalities
  • Lethargy, confusion, agitation, headache, nausea, and vomiting (correct)
  • Seizures and coma

    • What is a characteristic of urine osmolality in patients with hyponatremia?

  • Lower than serum osmolality
  • Equal to serum osmolality
  • Higher than serum osmolality (correct)
  • Less than 300 mosmol/L

    • What is the purpose of administering a water load and then hypertonic saline in diagnosing diabetes insipidus?

  • To stimulate ADH secretion and decrease urine flow (correct)
  • To determine the type of hyponatremia
  • To measure plasma osmolality
  • To diagnose pituitary insufficiency

    • What is the range of plasma osmolality in patients with diabetes insipidus?

    <p>280 - 310 mOsm/kg</p> Signup and view all the answers

    What is the primary cause of polyuria in diabetes insipidus?

    <p>Loss of free water</p> Signup and view all the answers

    What is an alternative method of differential diagnosis for diabetes insipidus?

    <p>MRI of the pituitary and hypothalamus</p> Signup and view all the answers

    What is a characteristic of hyponatremia in patients with multiple hormone deficiencies?

    <p>Low serum osmolality</p> Signup and view all the answers

    What is a common neurological manifestation of hyponatremia?

    <p>All of the above</p> Signup and view all the answers

    What is the normal function of ADH in the kidneys?

    <p>To decrease urine output and promote water reabsorption</p> Signup and view all the answers

    What is a characteristic of transient DI?

    <p>Abrupt onset and resolution within several days</p> Signup and view all the answers

    What is a physical manifestation of hyponatremia?

    <p>Decreased deep tendon reflexes</p> Signup and view all the answers

    What is a complication of ADH excess?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic of the permanent phase of polyuria in triphasic DI?

    <p>Gradual onset and permanent duration</p> Signup and view all the answers

    What is a clinical manifestation of ADH deficiency?

    <p>Polydipsia</p> Signup and view all the answers

    What is a diagnostic feature of hyponatremia?

    <p>Decreased serum Na+</p> Signup and view all the answers

    What is the primary cause of hyponatremia in the Syndrome of Inappropriate ADH secretion (SIADH)?

    <p>Resorption of excessive amounts of free water</p> Signup and view all the answers

    What is a neurological manifestation of ADH deficiency?

    <p>Mentation changes</p> Signup and view all the answers

    What is a characteristic of triphasic DI?

    <p>Gradual onset and three distinct phases</p> Signup and view all the answers

    Which of the following is a common cause of SIADH?

    <p>Small-cell carcinomas of the lung</p> Signup and view all the answers

    What is a complication of ADH deficiency?

    <p>All of the above</p> Signup and view all the answers

    What is the typical laboratory finding in pituitary insufficiency?

    <p>Low levels of trophic hormones</p> Signup and view all the answers

    Which of the following is a neurological manifestation of SIADH?

    <p>Neurologic dysfunction</p> Signup and view all the answers

    What is the primary diagnostic method for pituitary insufficiency?

    <p>Biochemical diagnosis</p> Signup and view all the answers

    What is the term for the unresponsiveness of the kidneys to ADH?

    <p>Nephrogenic DI</p> Signup and view all the answers

    What is the typical finding in the setting of secondary hypothyroidism?

    <p>Low free thyroxine and low TSH</p> Signup and view all the answers

    What is the primary difference between SIADH and nephrogenic DI?

    <p>SIADH is caused by ADH excess, while nephrogenic DI is caused by ADH deficiency</p> Signup and view all the answers

    Study Notes

    Hyponatremia

    • Symptoms of hyponatremia include lethargy, confusion, agitation, headache, nausea, and vomiting, and focal neurologic abnormalities
    • Seizures and coma may occur with more severe hyponatremia
    • Hyponatremia is present with low serum osmolality
    • Daily urinary sodium excretion exceeds 20 mEq/L, despite low serum sodium levels, and urine osmolality is higher than serum osmolality

    Diabetes Insipidus (DI)

    • Symptoms of DI include polyuria, clear urine, urinary frequency, nocturia, weight loss, and polydipsia
    • Physical manifestations include dry, cool skin, dry mucous membranes, tachycardia, fatigue, headache, anorexia, nausea, decreased mental status, seizures, and coma
    • Pathophysiology: ADH deficiency diminishes kidneys' permeability to water, resulting in excretion of large volumes of hypotonic fluid
    • Three patterns of DI may develop: transient DI, permanent DI, and triphasic DI

    Diagnosis

    • Diagnosis of DI is based on hyponatremia, low serum osmolality, and daily urinary sodium excretion exceeding 20 mEq/L
    • Administration of hypertonic saline and water load test can help distinguish DI from psychogenic polydipsia
    • MRI of the pituitary and hypothalamus can also aid in diagnosis

    Pathophysiology of ADH Excess

    • Key features of ADH excess include water retention, hyponatremia, and hypo-osmolality
    • ADH causes water retention from renal tubules and collecting ducts, increasing extracellular fluid volume and dilutional hyponatremia
    • Hyponatremia suppresses renin and aldosterone secretions, causing a decrease in proximal tubule reabsorption of Na+

    Physical Examination and Clinical Manifestations

    • Physical manifestations related to hyponatremia include decreased deep tendon reflexes, fatigue, headache, anorexia, nausea, and decreased mental status
    • Physical manifestations related to fluid volume excess include weight gain without edema, jugular venous distention, tachycardia, tachypnea, and rales

    Complications

    • Electrolyte imbalance, hypovolemia, hypotension, shock, seizures, coma, and permanent brain damage may occur

    Syndrome of Inappropriate ADH Secretion (SIADH)

    • SIADH is caused by ADH excess, leading to resorption of excessive amounts of free water, resulting in hyponatremia
    • The most frequent causes of SIADH include secretion of ectopic ADH by malignant neoplasms, drugs that increase ADH secretion, and central nervous system disorders
    • Clinical manifestations of SIADH are dominated by hyponatremia, cerebral edema, and resultant neurologic dysfunction

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    Description

    This quiz covers the symptoms, diagnosis, and effects of hyponatremia, a condition characterized by low sodium levels in the blood. Learn about the signs and consequences of hyponatremia.

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