Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • high fluid intake
  • fluid losses
  • history of diabetes mellitus
  • history of cirrhosis, nephrosis, congestive heart failure
  • nausea/vomiting
  • mild cognitive symptoms
  • altered mental status, seizures, coma
  • low urine output
  • weight changes
  • orthostatic hypotension
  • abnormal jugular venous pressure
  • poor skin turgor
  • dry mucus membranes
  • absence of axillary sweat
  • oedema
  • rales or crackles on lung auscultation
  • polyuria

Other diagnostic factors

  • history of hyperlipidaemia or paraproteinaemia

Risk factors

  • older age
  • hospitalisation
  • selective serotonin-reuptake inhibitor (SSRI) use
  • thiazide diuretic use
  • underlying medical conditions
  • use of other medications
  • ecstasy use

Diagnostic investigations

1st investigations to order

  • serum sodium concentration
  • serum electrolytes, urea, creatinine, and glucose
  • serum osmolality
  • urine sodium concentration
  • urine osmolality
  • urine electrolytes
  • urine flow rate
  • electrolyte-free water excretion
  • fractional excretion of sodium
  • TSH
  • serum cortisol level and/or ACTH test
  • serum lipids and serum protein electrophoresis
Full details

Investigations to consider

  • CT brain, chest, abdomen/pelvis
  • other tests targeted at evaluating the underlying cause
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Judith H. Veis

Associate Director

Nephrology

MedStar Washington Hospital Center

Washington

DC

Disclosures

JHV declares that she has no competing interests.

Peer reviewers VIEW ALL

Director

Department of Internal & Emergency Medicine

Hirslanden Klinik Im Park

Zurich

Switzerland

Disclosures

GL is the author of several references cited in this monograph.

Professor of Medicine

Division of Nephrology

Department of Medicine

Medical University of South Carolina

Charleston

SC

Disclosures

MEU declares that he has no competing interests.

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