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Initial Safety Concerns in Hyponatremia
- First, assess for neurological symptoms and determine if the hyponatremia is acute (within 48 hours) or chronic.
- If the patient is seizing or has altered mental status, administer 100cc 3% saline boluses over 10 minutes, repeatable up to three times.
True vs. Pseudo-Hyponatremia
- True hyponatremia is confirmed by low serum osmolality (<275 mOsm/kg), distinguishing it from pseudo-hyponatremia (normal or high serum osmolality).
- Pseudo-hyponatremia can be caused by high lipids or proteins, leading to a falsely low sodium measurement.
Diagnosing Hyponatremia Based on Kidney Function
- Instead of classifying hyponatremia by volume status, consider the kidney's activity: urine osmolality and electrolytes.
- Low urine osmolality (<100) suggests excess water intake relative to solute intake (e.g., psychogenic polydipsia).