Differentiating SIADH from Cerebral-Renal Salt Wasting: Failure of the Volume Approach and Need for a New Approach to HyponatremiaReport as inadecuate




Differentiating SIADH from Cerebral-Renal Salt Wasting: Failure of the Volume Approach and Need for a New Approach to Hyponatremia - Download this document for free, or read online. Document in PDF available to download.

1

Department of Medicine, Winthrop-University Hospital, Mineola, NY 11501, USA

2

Department of Medicine, Columbia University, New York, NY 10027, USA



These authors contributed equally to this work.





*

Author to whom correspondence should be addressed.



Abstract Hyponatremia is the most common electrolyte abnormality. Its diagnostic and therapeutic approaches are in a state of flux. It is evident that hyponatremic patients are symptomatic with a potential for serious consequences at sodium levels that were once considered trivial. The recommendation to treat virtually all hyponatremics exposes the need to resolve the diagnostic and therapeutic dilemma of deciding whether to water restrict a patient with the syndrome of inappropriate antidiuretic hormone secretion SIADH or administer salt and water to a renal salt waster. In this review, we briefly discuss the pathophysiology of SIADH and renal salt wasting RSW, and the difficulty in differentiating SIADH from RSW, and review the origin of the perceived rarity of RSW, as well as the value of determining fractional excretion of urate FEurate in differentiating both syndromes, the high prevalence of RSW which highlights the inadequacy of the volume approach to hyponatremia, the importance of changing cerebral salt wasting to RSW, and the proposal to eliminate reset osmostat as a subtype of SIADH, and finally propose a new algorithm to replace the outmoded volume approach by highlighting FEurate. This algorithm eliminates the need to assess the volume status with less reliance on determining urine sodium concentration, plasma renin, aldosterone and atrial-brain natriuretic peptide or the BUN to creatinine ratio. View Full-Text

Keywords: hyponatremia; renal salt wasting; fractional excretion urate FEurate; algorithm hyponatremia; renal salt wasting; fractional excretion urate FEurate; algorithm





Author: John K. Maesaka 1,* , Louis Imbriano 1,†, Joseph Mattana 1,†, Dympna Gallagher 2,†, Naveen Bade 1,† and Sairah Sharif 1,†

Source: http://mdpi.com/



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