Central pontine myelinolysis laboratory findings: Difference between revisions
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{{Central pontine myelinolysis}} | {{Central pontine myelinolysis}} | ||
{{CMG}}; {{AE}} {{ | {{CMG}}; {{AE}} {{MMJ}} | ||
==Overview== | ==Overview== | ||
Laboratory finding consistent with the diagnosis of central pontine myelinolysis is hypoosmotic [[hyponatremia]] and the rapid correction of [[hyponatremia]] is the cause of central pontine myelinolysis. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
Laboratory findings consistent with the diagnosis of central pontine myelinolysis include:<ref name="pmid24256958">{{cite journal| author=Burgetova A, Vaneckova M, Seidl Z, Dolezal O| title=Osmotic demyelination syndrome (central pontine and extrapontine myelinolysis with coagulative necrosis of the putamina and cortical laminar necrosis). A case report and review of the literature. | journal=Neuroradiol J | year= 2008 | volume= 21 | issue= 4 | pages= 521-6 | pmid=24256958 | doi=10.1177/197140090802100409 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24256958 }} </ref> | |||
*Hypoosmotic [[hyponatremia]] | |||
**The rapid correction of [[hyponatremia]] is the cause of central pontine myelinolysis. | |||
**The Common causes of [[hyponatremia]] include: | |||
[[Syndrome of inappropriate antidiuretic hormone|SIAD syndrome]] | |||
*'''<big>Etiologies of SIAD:</big>''' | |||
{| class="wikitable" | |||
! colspan="2" |'''<big>Conditions</big>''' | |||
|- | |||
!<big>Malignant disorders</big> | |||
|'''Carcinoma:''' Lung ( [[small cell carcinoma]], [[mesothelioma]]), oropharynx, stomach, duodenum, pancreas, ureter, bladder, prostate, endometrium, [[thymoma]] | |||
'''Lymphomas''' | |||
'''Sarcomas:''' [[Ewing's sarcoma]] | |||
'''Olfactory neuroblastoma''' | |||
|- | |||
!<big>Pulmonary diseases</big> | |||
|'''Infections:''' [[Bacterial pneumonia]], [[viral pneumonia]], [[pulmonary abscess]], [[tuberculosis]], [[aspergillosis]] | |||
'''Others:''' [[Asthma]], [[cystic fibrosis]], [[respiratory failure]], [[emphysema]], [[COPD]], positive-pressure ventilation | |||
|- | |||
!<big>CNS disorders</big> | |||
|'''Infections:''' Encephalitis, meningitis, brain abscess, [[RMSF]], [[AIDS]], [[malaria]] | |||
'''Vascular and SOP:''' [[Subarachnoid hemorrhage]], [[stroke]], [[brain tumors]], [[head trauma]] | |||
'''Others:''' [[Hydrocephalus]], [[cavernous sinus thrombosis]], [[Multiple sclerosis]], Guillain–Barré syndrome, Shy–Drager syndrome, | |||
[[delirium tremens]], [[Acute intermittent porphyrias|acute intermittent porphyria]], chronic psychosis, pituitary stalk section, transsphenoidal adenomectomy | |||
|- | |||
!<big>Other causes</big> | |||
|'''Hereditary:''' Gain-of-function mutation of V2 receptors | |||
'''Idiopathic''' | |||
'''[[#Drugs cause hyponatremia|Drugs]]''' | |||
'''Transient:''' [[Exercise]], [[general anesthesia]], nausea, pain, stress | |||
|} | |||
<br> | |||
* Causes of '''<big>acute hyponatremia:</big>''' | |||
{| class="wikitable" | |||
!Etiology | |||
|- | |||
| | |||
* Post operative phase | |||
* Transurethral or endoscopic procedure (mannitol, sorbitol, glycine) | |||
* Colonoscopy preparation | |||
* Polydipsia | |||
* Exercise | |||
* Oxytocin | |||
* Cyclophosphamide | |||
* Ecstasy( 3,4-Methylenedioxymethamphetamine, MDMA) | |||
* Thiazide | |||
* Halopridol | |||
* Recently started desmopressin, terlipressin, vasopressin | |||
|} | |||
<small>( Etiologies that cause hyperacute and acute hyponatremia are applicable to each category interchangeably depending on the onset of symptoms)</small> | |||
<br> | |||
* Causes of '''<big>Hyponatremia</big>''' based upon '''Serum Osmolality:''' | |||
{| class="wikitable" | |||
!Classification | |||
!Serum Osmolality | |||
!Etiology | |||
|- | |||
|'''<big>Hypertonic or Isotonic Hyponatremia</big>''' | |||
|> 295 mOsm/kg | |||
|[[Hyperglycemia]]<sup>‡</sup>, [[Mannitol]], [[Glycine]], [[Maltose]], severe [[azotemia]] | |||
|- | |||
|'''<big>Isotonic Hyponatremia</big>''' | |||
'''(Pseudohyponatremia)''' | |||
|275 – 295 mOsm/kg | |||
|Lab/blood draw error, Post TURP (bladder irrigation with osmotic solutions), | |||
intravenous immunoglobulin (IVIg), Hyperlipidemia ( triglyceride, cholesterol ), | |||
hyper paraproteinemia (monoclonal gammopathy of undetermined significance (MGUS), | |||
multiple myeloma), | |||
|- | |||
|'''<big>Hypotonic Hyponatremia</big>''' | |||
|< 275 mOsm/kg | |||
|[[Glycerol]], [[Sorbitol]], Etiology depends upon volume status (Hypervolemic/ Euvolemic/ Hypovolemic) | |||
|- | |||
| colspan="3" |<small>[[Alcohol]], [[Urea]], Ethylen glycol are ineffective osmoles, cause hyperosmolar isotonic serum but not hyponatremia.</small> | |||
|} | |||
<small>‡ Hyperglycemia causes osmotic diuresis results in a rise in serum sodium concentration, on the other hand it leads to extracellular shift of water due to osmotic gradient which causes relative hyponatremia , depends on which effect is stronger, there would be hypertonicity or hypotonicity<ref>{{Cite journal | |||
| author = [[A. I. Arieff]] & [[H. J. Carroll]] | |||
| title = Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases | |||
| journal = [[Medicine]] | |||
| volume = 51 | |||
| issue = 2 | |||
| pages = 73–94 | |||
| year = 1972 | |||
| month = March | |||
| pmid = 5013637 | |||
}}</ref>.</small> | |||
* Causes of '''<big>Hyponatremia</big>''' based on '''volume status''' '''<ref name="GuillauminDiBartola2017">{{cite journal|last1=Guillaumin|first1=Julien|last2=DiBartola|first2=Stephen P.|title=A Quick Reference on Hyponatremia|journal=Veterinary Clinics of North America: Small Animal Practice|volume=47|issue=2|year=2017|pages=213–217|issn=01955616|doi=10.1016/j.cvsm.2016.10.003}}</ref> :''' | |||
{| class="wikitable" | |||
!Volume status | |||
!Sodium status | |||
!Causes | |||
|- | |||
|'''<big>Hypovolemic</big>''' | |||
'''<big>Hyponatremia<ref name="Rondon-BerriosAgaba2014">{{cite journal|last1=Rondon-Berrios|first1=Helbert|last2=Agaba|first2=Emmanuel I.|last3=Tzamaloukas|first3=Antonios H.|title=Hyponatremia: pathophysiology, classification, manifestations and management|journal=International Urology and Nephrology|volume=46|issue=11|year=2014|pages=2153–2165|issn=0301-1623|doi=10.1007/s11255-014-0839-2}}</ref>''' | |||
| | |||
* total body water ↓ | |||
* total body sodium ↓↓ | |||
| | |||
* '''GI loss:''' [[Vomiting]], [[Diarrheal|diarrhea]], tube drainage | |||
* '''Insensible loss:''' [[Sweating]], [[burns]] | |||
* '''Renal loss:''' Salt-wasting nephropathy (inappropriate loss of Na+-Cl– in the urine), | |||
bicarbonaturia ( renal tubular acidosis, metabolic alkalosis), [[osmotic diuresis]], [[diuretic use]], | |||
[[cerebral salt-wasting syndrome]] ([[Stroke]] ,[[SAH]] ,↑ [[brain natriuretic peptide]] and ↑ renal sodium loss ) | |||
* '''Third spacing of fluids :''' [[Pancreatitis]], [[hypoalbuminemia]], [[Small bowel obstruction]] | |||
* '''Mineralocorticoid deficiency:''' [[Addison disease]] (primary) | |||
* '''Excessive diuretic administration''' | |||
|- | |||
|'''<big>Hypervolemic</big>''' | |||
'''<big>Hyponatremia</big>''' | |||
| | |||
* total body water '''↑↑''' | |||
* total body sodium ↑ | |||
| | |||
* '''Renal disease:''' Acute or chronic kidney disease or injury | |||
(due to relatively higher water versus salt intake and poor excretion), nephrotic syndrome | |||
* '''Congestive heart failure''' | |||
* '''Cirrhosis''' | |||
* '''Iatrogenic''' | |||
|- | |||
|'''<big>Euvolemic</big>''' | |||
'''<big>Hyponatremia</big>''' | |||
| | |||
* total body water ↑ | |||
* total body sodium ↔ | |||
| | |||
* '''Drugs:''' [[Vasopressin]], [[diuretics]], [[antidepressants]], [[opioids]] | |||
* '''SIAD:''' [[SIADH]] (Malignancy, central nervous system (CNS) disorders, pulmonary disease, or drugs, | |||
postoperative nausea, pain, stress, neoplasia (common), trauma, pregnancy) | |||
''',''' nephrogenic SIAD (Gain-of-function mutation of v2 receptors) | |||
* '''High fluid intake:''' Physical activity, surgery, primary polydipsia, potomania, tea & toast diet | |||
(caused by a low intake of solutes with relatively high fluid intake) | |||
* '''Medical testing''' (excess fluid intake) ''':'''[[Colonoscopy]] or [[cardiac catheterization]] | |||
* '''Hypothyroidism''' | |||
* '''Hormonal:''' [[Glucocorticoid deficiency 1|Glucocorticoid deficiency]], [[pituitary failure]] (secondary), hypothalamic failure (tertiary) | |||
* '''Reset osmostat <sup>†</sup> :''' Drugs, pregnancy | |||
* '''Iatrogenic''' | |||
|} | |||
''<small>† Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors</small>'' | |||
<br> | |||
* <big>'''Drugs''' which cause '''hyponatremia:'''</big> | |||
{| class="wikitable" | |||
!'''<big>Drug Mechanisms <ref name="LiamisMilionis200822">{{cite journal|last2=Milionis|first2=Haralampos|last3=Elisaf|first3=Moses|year=2008|title=A Review of Drug-Induced Hyponatremia|journal=American Journal of Kidney Diseases|volume=52|issue=1|pages=144–153|doi=10.1053/j.ajkd.2008.03.004|issn=02726386|last1=Liamis|first1=George}}</ref></big>''' | |||
!'''<big>Drug Classification</big>''' | |||
|- | |||
!'''<big>Increase ADH secretion</big>''' | |||
|'''Antidepressants:'''[[Tricyclic antidepressants]] ( [[Amitryptiline]], | |||
[[Protriptyline]], [[Desipramine]]),[[Selective serotonin reuptake inhibitors]], | |||
[[Monoamine oxidase inhibitors]] | |||
'''Antipsychotic drugs:''' [[Phenothiazines]] ([[Thioridazine]], [[Trifluoperazine]]), | |||
[[Butyrophenones]] ([[Haloperidol]]) | |||
'''Antiepileptic drugs:''' [[Carbamazepine]], [[Oxcarbazepine]], [[Sodium valproate]] | |||
'''Anticancer agents:''' [[Vinca alkaloids]] ([[Vincristine]], [[Vinblastine]]), | |||
Platinum compounds ([[Cisplatinum|Cisplatin]], [[Carboplatinum|Carboplatin]]) | |||
'''Alkylating agents:''' Intravenous [[Cyclophosphamide lyophilized|Cyclophosphamide]], [[Melphalan]], [[Ifosfamide]] | |||
'''Miscellaneous:''' [[Methotrexate Sodium|Methotrexate]], [[Interferon]], [[Levamisole]], [[Pentostatin]], [[Monoclonal antibodies]], [[MDMA]], [[Nicotine]] | |||
[ | '''Opiates''' | ||
|- | |||
!<big>Increase ADH effect</big> | |||
|'''Antiepileptic drugs:''' [[Carbamazepine]], [[Lamotrigine]] | |||
'''Antidiabetic drugs:''' [[Chlorpropamide]], [[Tolbutamide]] | |||
'''Anticancer agents:''' Alkylating agents (Intravenous [[Cyclophosphamide lyophilized|cyclophosphamide]]) | |||
'''NSAIDS''' | |||
|- | |||
!<big>Drugs affecting water and sodium homeostasis</big> | |||
|'''Diuretics:''' [[Thiazides]], [[Indapamide]], [[Amiloride]], [[Loop diuretics]] | |||
|- | |||
!<big>Reset omostat <sup>‡</sup></big> | |||
|'''Antidepressants:''' [[Venlafaxine]] | |||
'''Antiepileptic drugs:''' [[Carbamazepine]] | |||
|- | |||
!<big>Vasopressin analogues</big> | |||
|[[Desmopressin]], [[oxytocin]], [[terlipressin]], [[Vasopressin analogue|vasopressin]] | |||
|} | |||
<small>‡ ''Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors'' | |||
</small> | |||
===Causes by Organ System=== | |||
{| style="width:80%; height:100px" border="1" | |||
| style="width:25%" bgcolor="lightsteelblue" ; border="1" | '''Cardiovascular''' | |||
| style="width:75%" bgcolor="beige" ; border="1" | [[Congestive heart failure ]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Chemical / poisoning''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Dermatologic''' | |||
| bgcolor="beige" | [[Burns]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Drug Side Effect''' | |||
| bgcolor="beige" | [[ACE inhibitors]], [[Ajuga nipponensis makino ]] , [[Asenapine maleate]], [[Cefpodoxime]], [[Chlorpropamide]], [[Cyclophosphamide]], [[Desmopressin]], [[Diuretics]], [[Duloxetine]], [[Eslicarbazepine acetate]], [[Ethacrynic Acid]], [[Felbamate]], [[Fluvoxamine]], [[Interferon gamma]], [[Ixabepilone]], [[Losartan and Hydrochlorothiazide]], [[Nilotinib]], [[Nivolumab]], [[Nonsteriodal anti-inflammatory drugs ]] , [[Oxcarbazepine]], [[Pramipexole]], [[Rifaximin]], [[Tiagabine]], [[Tolazamide]], [[Zonisamide]], [[Tolbutamide]], [[Vortioxetine]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Ear Nose Throat''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Endocrine''' | |||
| bgcolor="beige" | [[Addison's disease]], [[Corticosterone methyloxidase type I deficiency ]] , [[Diabetes mellitus]], [[Diabetic coma]], [[Glucocorticoid deficiency]], [[Familial hyperreninemic hypoaldosteronism type 2]], [[Hypothyroidism]], [[Mineralocorticoid deficiency]], [[Myxedema coma ]] , [[Syndrome of inappropriate antidiuretic hormone ]] , [[Thyrotropin deficiency]], [[18-Hydroxylase deficiency ]] , [[Familial hypoaldosteronism ]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Environmental''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Gastroenterologic''' | |||
| bgcolor="beige" | [[Acute liver failure ]] , [[Cirrhosis]], [[Congenital chloride diarrhea ]] , [[Diarrhea]], [[Gastrointestinal fistula]], [[Ileus]], [[Necrotizing enterocolitis ]] , [[Pancreatitis]], [[Peritonitis]], [[Vomiting]], [[Cystic fibrosis]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Genetic''' | |||
| bgcolor="beige" | [[18-Hydroxylase deficiency ]] , [[Bartter Syndrome type 4 ]] , [[Cystic fibrosis]], [[Familial hypoaldosteronism ]] , [[Corticosterone methyloxidase type I deficiency ]] , [[Familial hyperreninemic hypoaldosteronism type 2]], [[Congenital chloride diarrhea ]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Hematologic''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Iatrogenic''' | |||
| bgcolor="beige" | [[After pituitary surgery]], [[After surgery]], [[Ascitic tap]], [[Gastric drainage]], [[Hypotonic infusions]], [[Pleuracentesis]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Infectious Disease''' | |||
| bgcolor="beige" | [[Malignant boutonneuse fever ]] , [[Neonatal bacterial meningitis ]] , [[Peritonitis]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Musculoskeletal / Ortho''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Neurologic''' | |||
| bgcolor="beige" | [[Intracranial hemorrhage]], [[Subarachnoid hemorrhage]], [[Pituitary cancer]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Nutritional / Metabolic''' | |||
| bgcolor="beige" | [[Hyperlipidemia]], [[Hyperproteinemia]], [[Hypoalbuminemia]], [[Low sodium diet]], [[Metabolic acidosis]], [[Diabetic coma]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Obstetric/Gynecologic''' | |||
| bgcolor="beige" | [[Pregnancy]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Oncologic''' | |||
| bgcolor="beige" | [[Pituitary cancer]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Opthalmologic''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Overdose / Toxicity''' | |||
| bgcolor="beige" | [[Water intoxication]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Psychiatric''' | |||
| bgcolor="beige" | [[Psychogenic polydipsia]], [[Psychosis]], [[Self-induced water intoxication and schizophrenic disorders syndrome ]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Pulmonary''' | |||
| bgcolor="beige" | [[Cystic fibrosis]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Renal / Electrolyte''' | |||
| bgcolor="beige" | [[Acute kidney disease]], [[Chronic kidney disease]], [[Diuresis]], [[Glucosuria]], [[Ketonuria]], [[Nephrotic syndrome]], [[Renal Tubular Acidosis]], [[Tubulointerstitial kidney disease]], [[Bartter Syndrome type 4 ]] , [[Corticosterone methyloxidase type I deficiency ]] , [[Renal failure]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Rheum / Immune / Allergy''' | |||
| bgcolor="beige" | [[Addison's disease]], [[Nephrotic syndrome]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Sexual''' | |||
| bgcolor="beige" | [[Cystic fibrosis]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Trauma''' | |||
| bgcolor="beige" | [[Burns]] | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Urologic''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Dental''' | |||
| bgcolor="beige" | No underlying causes | |||
|- | |||
|- bgcolor="lightsteelblue" | |||
| '''Miscellaneous''' | |||
| bgcolor="beige" | [[Beer potomania]], [[Ecstasy abuse ]] , [[Factitious hyponatremia]], [[Hydration]], [[Massive edema]], [[Pseudohyponatremia]], [[Water Intoxication ]] , [[Hyperlipidemia]], [[Hyperproteinemia]], [[Hypoalbuminemia]], [[Exercise associated hyponatremia]] | |||
|- | |||
|} | |||
=== Causes in Alphabetical Order=== | |||
==References== | ==References== |
Latest revision as of 03:57, 29 January 2020
Central pontine myelinolysis Microchapters |
Differentiating Central pontine myelinolysis from other Diseases |
---|
Diagnosis |
Treatment |
Case Studies |
Central pontine myelinolysis laboratory findings On the Web |
American Roentgen Ray Society Images of Central pontine myelinolysis laboratory findings |
Central pontine myelinolysis laboratory findings in the news |
Risk calculators and risk factors for Central pontine myelinolysis laboratory findings |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Laboratory finding consistent with the diagnosis of central pontine myelinolysis is hypoosmotic hyponatremia and the rapid correction of hyponatremia is the cause of central pontine myelinolysis.
Laboratory Findings
Laboratory findings consistent with the diagnosis of central pontine myelinolysis include:[1]
- Hypoosmotic hyponatremia
- The rapid correction of hyponatremia is the cause of central pontine myelinolysis.
- The Common causes of hyponatremia include:
- Etiologies of SIAD:
Conditions | |
---|---|
Malignant disorders | Carcinoma: Lung ( small cell carcinoma, mesothelioma), oropharynx, stomach, duodenum, pancreas, ureter, bladder, prostate, endometrium, thymoma
Lymphomas Sarcomas: Ewing's sarcoma Olfactory neuroblastoma |
Pulmonary diseases | Infections: Bacterial pneumonia, viral pneumonia, pulmonary abscess, tuberculosis, aspergillosis
Others: Asthma, cystic fibrosis, respiratory failure, emphysema, COPD, positive-pressure ventilation |
CNS disorders | Infections: Encephalitis, meningitis, brain abscess, RMSF, AIDS, malaria
Vascular and SOP: Subarachnoid hemorrhage, stroke, brain tumors, head trauma Others: Hydrocephalus, cavernous sinus thrombosis, Multiple sclerosis, Guillain–Barré syndrome, Shy–Drager syndrome, delirium tremens, acute intermittent porphyria, chronic psychosis, pituitary stalk section, transsphenoidal adenomectomy |
Other causes | Hereditary: Gain-of-function mutation of V2 receptors
Idiopathic Transient: Exercise, general anesthesia, nausea, pain, stress |
- Causes of acute hyponatremia:
Etiology |
---|
|
( Etiologies that cause hyperacute and acute hyponatremia are applicable to each category interchangeably depending on the onset of symptoms)
- Causes of Hyponatremia based upon Serum Osmolality:
Classification | Serum Osmolality | Etiology |
---|---|---|
Hypertonic or Isotonic Hyponatremia | > 295 mOsm/kg | Hyperglycemia‡, Mannitol, Glycine, Maltose, severe azotemia |
Isotonic Hyponatremia
(Pseudohyponatremia) |
275 – 295 mOsm/kg | Lab/blood draw error, Post TURP (bladder irrigation with osmotic solutions),
intravenous immunoglobulin (IVIg), Hyperlipidemia ( triglyceride, cholesterol ), hyper paraproteinemia (monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma), |
Hypotonic Hyponatremia | < 275 mOsm/kg | Glycerol, Sorbitol, Etiology depends upon volume status (Hypervolemic/ Euvolemic/ Hypovolemic) |
Alcohol, Urea, Ethylen glycol are ineffective osmoles, cause hyperosmolar isotonic serum but not hyponatremia. |
‡ Hyperglycemia causes osmotic diuresis results in a rise in serum sodium concentration, on the other hand it leads to extracellular shift of water due to osmotic gradient which causes relative hyponatremia , depends on which effect is stronger, there would be hypertonicity or hypotonicity[2].
- Causes of Hyponatremia based on volume status [3] :
Volume status | Sodium status | Causes |
---|---|---|
Hypovolemic
Hyponatremia[4] |
|
bicarbonaturia ( renal tubular acidosis, metabolic alkalosis), osmotic diuresis, diuretic use, cerebral salt-wasting syndrome (Stroke ,SAH ,↑ brain natriuretic peptide and ↑ renal sodium loss )
|
Hypervolemic
Hyponatremia |
|
(due to relatively higher water versus salt intake and poor excretion), nephrotic syndrome
|
Euvolemic
Hyponatremia |
|
postoperative nausea, pain, stress, neoplasia (common), trauma, pregnancy) , nephrogenic SIAD (Gain-of-function mutation of v2 receptors)
(caused by a low intake of solutes with relatively high fluid intake)
|
† Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors
- Drugs which cause hyponatremia:
Drug Mechanisms [5] | Drug Classification |
---|---|
Increase ADH secretion | Antidepressants:Tricyclic antidepressants ( Amitryptiline,
Protriptyline, Desipramine),Selective serotonin reuptake inhibitors, Antipsychotic drugs: Phenothiazines (Thioridazine, Trifluoperazine), Antiepileptic drugs: Carbamazepine, Oxcarbazepine, Sodium valproate Anticancer agents: Vinca alkaloids (Vincristine, Vinblastine), Platinum compounds (Cisplatin, Carboplatin) Alkylating agents: Intravenous Cyclophosphamide, Melphalan, Ifosfamide Miscellaneous: Methotrexate, Interferon, Levamisole, Pentostatin, Monoclonal antibodies, MDMA, Nicotine Opiates |
Increase ADH effect | Antiepileptic drugs: Carbamazepine, Lamotrigine
Antidiabetic drugs: Chlorpropamide, Tolbutamide Anticancer agents: Alkylating agents (Intravenous cyclophosphamide) NSAIDS |
Drugs affecting water and sodium homeostasis | Diuretics: Thiazides, Indapamide, Amiloride, Loop diuretics |
Reset omostat ‡ | Antidepressants: Venlafaxine
Antiepileptic drugs: Carbamazepine |
Vasopressin analogues | Desmopressin, oxytocin, terlipressin, vasopressin |
‡ Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors
Causes by Organ System
Causes in Alphabetical Order
References
- ↑ Burgetova A, Vaneckova M, Seidl Z, Dolezal O (2008). "Osmotic demyelination syndrome (central pontine and extrapontine myelinolysis with coagulative necrosis of the putamina and cortical laminar necrosis). A case report and review of the literature". Neuroradiol J. 21 (4): 521–6. doi:10.1177/197140090802100409. PMID 24256958.
- ↑ A. I. Arieff & H. J. Carroll (1972). "Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases". Medicine. 51 (2): 73–94. PMID 5013637. Unknown parameter
|month=
ignored (help) - ↑ Guillaumin, Julien; DiBartola, Stephen P. (2017). "A Quick Reference on Hyponatremia". Veterinary Clinics of North America: Small Animal Practice. 47 (2): 213–217. doi:10.1016/j.cvsm.2016.10.003. ISSN 0195-5616.
- ↑ Rondon-Berrios, Helbert; Agaba, Emmanuel I.; Tzamaloukas, Antonios H. (2014). "Hyponatremia: pathophysiology, classification, manifestations and management". International Urology and Nephrology. 46 (11): 2153–2165. doi:10.1007/s11255-014-0839-2. ISSN 0301-1623.
- ↑ Liamis, George; Milionis, Haralampos; Elisaf, Moses (2008). "A Review of Drug-Induced Hyponatremia". American Journal of Kidney Diseases. 52 (1): 144–153. doi:10.1053/j.ajkd.2008.03.004. ISSN 0272-6386.