Author declares no conflict of interest.

In addition to the presenter, following authors who may have helped with the content writing, review, or approval declare no conflict of interest.

  • Dr. Mobeen Syed
  • Dr. Pei Purdom (DNP)
  • Dr. Benish Zahra
  • Dr. Iqra Batool
  • Dr. Heba Alzawahri

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Diagnosis and Treatment of Hyponatremia

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Dear Dr Verduzco,

I have admitted an elderly male patient with altered mental status. He got constipation and was given unknown medicine diluted in a large amount of water (about 2 liters), given by his wife. Since then, he developed vomiting and was supplied free water (unknown amount). He was admitted with GCS of 6 (E1V1M4), dry skin, Plasma Na+ 108, urine Na+ 78, normal brain MRI, Plasma Glucose 280mg/dL, Ketones/ urine dipstick (+), Anion gap 19.2 (plasma OSM, urine OSM, plasma and urine ketones results were not available immediately). His internal jugular vein was collapsed seen by ultrasound during my central venous catheterisation. Later, he developed hypotension. Looking back to his history, I found that his plasma Na+ half year before was 131-135 in constant and diabetes mellitus.
I would like to ask whether this case is only acute hypotonic hyponatremia or a combination of both hypotonic hyponatremia and ketoacidosis? At the time of hypotension, would giving 0.9% saline for resuscitation worsen the hyponatremia? Is treating ketoacidosis necessary or not? I have been confused about this case and hope you could help me clarify it.

Thank you.

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In this lecture, we review sodium homeostasis in the human body as well as hyponatremia. Critical care management of hyponatremia is discussed. The differential diagnosis of hyponatremia will be outlined and an approach to its etiology is reviewed.

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Luis A Verduzco M.D.

Luis A. Verduzco M.D. is certified by the American Board of Anesthesiology in anesthesiology and critical care medicine. He completed his undergraduate degree with distinction from Yale University and then went on to medical school at Harvard, having graduated as an Arthur Lehman and LInnane Scholar. Dr Verduzco received his residency training at Stanford and was elected chief resident during his final year. He stayed at Stanford for critical care fellowship training. He is a former Academy of Achievement Student Delegate and Howard Hughes Medical Institute Research Training Fellow. Dr Verduzco has authored multiple book chapters and peer-reviewed manuscripts, with primary authorships in prestigious journals such as Stroke and Blood. He is an avid learner who practices evidence-based medicine and enjoys teaching.

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