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15 - Hyponatraemia

Published online by Cambridge University Press:  15 February 2010

Amanda Ogilvy-Stuart
Affiliation:
University of Cambridge
Paula Midgley
Affiliation:
University of Edinburgh
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Summary

Clinical presentation

  • Incidental finding on blood test.

  • Collapse (see Chapter 13).

Definition

Plasma sodium <130 mmol/L.

Approach to the problem

To distinguish between water overload (excessive intake or inadequate output) and sodium depletion (excessive salt loss).

Other features to look for:

  • Pigmented scrotum (see Chapter 11) or ambiguous genitalia (see Chapters 8 and 10) suggesting congenital adrenal hyperplasia.

  • Plasma potassium measurement.

  • Palpable kidney, or mass (renal vein thrombosis, adrenal haemorrhage).

  • Family history of renal problems.

  • Blood pressure (liable to be raised in renal rather than adrenal disorders).

Differential diagnosis

May be informed by consideration of:

  • Postnatal age (low glomerular filtration rate in the first few days of life).

  • Gestational age (renal immaturity resulting in salt loss).

Water overload:

  • latrogenic: This is the commonest cause, and may start before birth, i.e. secondary to excess maternal intravenous (IV) fluid administration.

  • Renal failure.

  • Syndrome of inappropriate antidiuretic hormone secretion (SIADH) (intracranial pathology: asphyxia, meningitis; intrathoracic pathology: pneumothorax).

Salt depletion:

  • Immaturity (extreme preterm infant usually from the end of first week of life).

  • Congenital adrenal hyperplasia (usually days 4–10).

  • Congenital adrenal hypoplasia.

  • Renal impairment, e.g. polyuric phase of acute tubular necrosis (ATN), congenital nephrotic syndrome, Bartter syndrome (hyperprostaglandin E syndrome, associated with life-threatening hypokalaemia). Congenital renal abnormality (there may be a history of polyhydramnios secondary to excessive urine output in utero).

  • […]

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Publisher: Cambridge University Press
Print publication year: 2006

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  • Hyponatraemia
  • Amanda Ogilvy-Stuart, University of Cambridge, Paula Midgley, University of Edinburgh
  • Book: Practical Neonatal Endocrinology
  • Online publication: 15 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544736.016
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  • Hyponatraemia
  • Amanda Ogilvy-Stuart, University of Cambridge, Paula Midgley, University of Edinburgh
  • Book: Practical Neonatal Endocrinology
  • Online publication: 15 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544736.016
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Hyponatraemia
  • Amanda Ogilvy-Stuart, University of Cambridge, Paula Midgley, University of Edinburgh
  • Book: Practical Neonatal Endocrinology
  • Online publication: 15 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544736.016
Available formats
×