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CLINICAL APPROACH TO HYPONATREMIA
Plasma Osmolality
High
Hyperglycemia Mannitol
Normal
Hyperproteinemia Hyperlipidemia Bladder irrigation
Low
Maximal volume of maximally dilute urine (<100 mosmol/kg)
ECF volume
Primary polydipsia Reset osmostat
Increased
Heart failure Hepatic cirrhosis Nephrotic syndrome Renal insufficiency
Normal
SIADH Exclude hypothyroidism Exclude adrenal insufficiency
Decreased
Urine Na+ concentration
<10 mmol/L
Extrarenal Na+ loss Remote diuretic use Remote vomiting
>20 mmol/L
Na+-wasting nephropathy Hypoaldosteronism Diuretic Vomiting
Yes
No
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