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    Differential diagnosis of hyponatraemia.

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    Authors
    Thompson, Chris
    Berl, Tomas
    Tejedor, Alberto
    Johannsson, Gudmundur
    Affiliation
    Academic Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont Road, Dublin 9, Ireland. christhompson@beaumont.ie
    Issue Date
    2012-03
    MeSH
    Algorithms
    Blood Volume
    Diagnosis, Differential
    Endocrine System Diseases
    Humans
    Hyponatremia
    Inappropriate ADH Syndrome
    Nervous System Diseases
    Osmolar Concentration
    Sodium
    Urine
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    Citation
    Differential diagnosis of hyponatraemia. 2012, 26 Suppl 1:S7-15 Best Pract. Res. Clin. Endocrinol. Metab.
    Journal
    Best practice & research. Clinical endocrinology & metabolism
    URI
    http://hdl.handle.net/10147/237851
    DOI
    10.1016/S1521-690X(12)70003-9
    PubMed ID
    22469249
    Abstract
    The appropriate management of hyponatraemia is reliant on the accurate identification of the underlying cause of the hyponatraemia. In the light of evidence which has shown that the use of a clinical algorithm appears to improve accuracy in the differential diagnosis of hyponatraemia, the European Hyponatraemia Network considered the use of two algorithms. One was developed from a nephrologist's view of hyponatraemia, while the other reflected the approach of an endocrinologist. Both of these algorithms concurred on the importance of assessing effective blood volume status and the measurement of urine sodium concentration in the diagnostic process. To demonstrate the importance of accurate diagnosis to the correct treatment of hyponatraemia, special consideration was given to hyponatraemia in neurosurgical patients. The differentiation between the syndrome of inappropriate antidiuretic hormone secretion (SIADH), acute adrenocorticotropic hormone (ACTH) deficiency, fluid overload and cerebral salt-wasting syndrome was discussed. In patients with SIADH, fluid restriction has been the mainstay of treatment despite the absence of an evidence base for its use. An approach to using fluid restriction to raise serum tonicity in patients with SIADH and to identify patients who are likely to be recalcitrant to fluid restriction was also suggested.
    Item Type
    Article
    Language
    en
    ISSN
    1532-1908
    ae974a485f413a2113503eed53cd6c53
    10.1016/S1521-690X(12)70003-9
    Scopus Count
    Collections
    Beaumont Hospital

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