Hyponatremia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2] Saeedeh Kowsarnia M.D.[3]

Overview

Hyponatremia must be differentiated from other diseases that cause muscle weakness or cramps, oliguria, vomiting or diarrhea and seizures.

Differentiating Hyponatremia from other Diseases

Disease	Clinical manifestations												Paraclinical Findings
	Symptoms and Signs												Lab Findings
	Muscle weakness/ Cramps	Seizures	Oliguria	Vomiting/ Diarrhea	Volume status	JVP	Edema	Crackles	Ascites	Tachycardia	Hypotension	Dry mucous membranes	Urine Analysis			Serum Osmolality	ADH levels
													Urine Na	Urine Osm	FeNa
Renal failure	+/-	+/-	+/-	-	Hypervolemic	+	+	+	+	-	-	-	>20	-	>1%	-	Normal or ↑
Congestive heart failure	+/-	+/-	-	-	Hypervolemic	+	+	+	+	-	-	-	<10	-	<1%	-	↑
Cirrhosis	+/-	+/-	-	-	Hypervolemic	+	+	+	+	-	-	-	<10	-	<1%	-	↑
SIADH	+/-	+/-	-	-	Euvolemic	-	-	-	-	-	-	-	-	>100	-	-	↑
Hypothyroidism	+/-	+/-	-	-	Euvolemic	-	-	-	-	-	-	-	-	>100	-	-	↑
Adrenal insufficiency	+/-	+/-	-	-	Euvolemic	-	-	-	-	-	-	-	-	>100	-	-	↑
Psychogenic polydipsia	+/-	+/-	-	-	Euvolemic	-	-	-	-	-	-	-	-	<100	-	-	↑
Beer drinker's potomania	+/-	+/-	-	-	Euvolemic	-	-	-	-	-	-	-	-	<100	-	-	↓
Pregnancy	+/-	+/-	-	-	Euvolemic	-	-	-	-	-	-	-	-	Variable	-	-	↓
Anorexia (Chronic malnutrition)	+/-	+/-	-	-	Euvolemic	-	-	-	-	-	-	-	-	Variable	-	-	-
Diuretic induced hyponatremia	+/-	+/-	+	-	Hypovolemic	-	-	-	-	+	+	+	>20	-	>1%	-	-
Non oliguric ATN	+/-	+/-	-	-	Hypovolemic	-	-	-	-	+	+	+	>20	-	>1%	-	-
Diseases causing 3rd spacing (Pancreatitis, SBO)	+/-	+/-	+	+/-	Hypovolemic	-	-	-	-	+	+	+	<10	-	<1%	-	-
Gastroenteritis	+/-	+/-	+	+	Hypovolemic	-	-	-	-	+	+	+	<10	-	<1%	-	-
Sweating	+/-	+/-	+	-	Hypovolemic	-	-	-	-	-	+/-	+/-	<10	-	<1%	-	-
Cerebral salt-wasting syndrome