Which of the following is associated with hyponatremia and low osmolality
Ans. is 'c' i.e., CHF CHF is characterised by low perfusion of kidneys stimulating R.A.A.S and resultant absorption of salt and dispropoionate amout of water would lead to hyponatremia with decreased osmolality. Isotonic hyponatremia is seen with hyperlipidemia and hvperproteinemia like in paraproteinemia. Intravenous immunoglobulin therapy also interferes with measurement of serum sodium. Major causes of hyponatremia Disorders in which ADH levels are elevated Effective circulating volume depletion True volume depletion Hea failure Cirrhosis Thiazide diuretics Syndrome of inappropriate ADH secretion, including reset osmostat pattern Hormonal changes Adrenal insufficiency Hypothyroidism Pregnancy Disorders in which ADH levels may be appropriately suppressed Advanced renal failure Primary polydipsia Beer drinker's potomania Hyponatremia with normal or elevated plasma osmolality High plasma osmolality (effective osmols) Hyperglycemia Mannitol High plasma osmolality (ineffective osmols) Renal failure Alcohol intoxication with an elevated serum alcohlo concentration Normal plasma osmolality Psedohyponatremia (laboratory aifact) High triglycerides Chloestatic and obstructive jaundice (lipoprotein x) Multiple myeloma Absorption of irrigant solutions Glycine Sorbitol Mannitol
Hyperlipidemia
SIADH
CHF
CKD