2014-18 olar Disorde Depletion effective solutes such as Primary Decreases in Total Body solute very high concentrations of glucose in diabetic patients or Secondary Water Retention Isotonic hyponatremia: hyperlipidemia or marked perglobulinemia-pseudohyponatremia True hypotonic hyponatremia: portant underlying disorder that leads to abnormal dy water balanc the hypotonic state indicates either past or ongoing ution(Primary Increases in Total Body Water* Secondary Solute Primary Decreases in Total Body Solute Secondary Water Impaired Renal Free Water Excretion Retention mpaired Distal Dilution inappropriate antidiuretic hormone secretion(SIADH) Combined Increased Proximal Reabsorption and impa ired Distal Nonrenal Solute Loss Gastrointestinal (diarrhea, vomiting, pancreatitis, bowel Congestive heart failure obstruction utaneous(sweating, burns Blood loss Decreased Urinary Solute Excretion Beer pototan Excess Water Intake Diagnostic Criteria for the Syndrome of Inappropriate ADH Release AL NERVOUS SYSTEM DISORDER Essential Diagnostic Criteria 1 c2ro mosman H or mud erective osmoasly Inappropriate urinary concentration (>100 mosm/kg H2 O) PULMONARY DESORDEI DH Elevated urinary Na concentration under conditions of normal Absence of adrenal, thyroid, pituitary, or renal insufficiency or ED Criterin 物bm H level inappropriately elevated relative to No significant correction af plasma Na level with volume 52014-1-8 5 • Hypertonic hyponatremia: an accumulation in the ECF compartment of non-sodium-containing effective solutes such as – very high concentrations of glucose in diabetic patients or – exogenously administered mannitol or glycerol. • Isotonic hyponatremia: hyperlipidemia or marked hyperglobulinemia – pseudohyponatremia • True hypotonic hyponatremia: – an important underlying disorder that leads to abnormal body water balance, – the hypotonic state indicates either past or ongoing expansion of ICF volume. Hypo-osmolar Disorders • Depletion: – Primary Decreases in Total Body Solute + Secondary Water Retention • Dilution: – Primary Increases in Total Body Water ± Secondary Solute Depletion Causes of SIADH